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. CHECK OF'F'LIST FOR ISSUANCE OF PERMITS <br /> � FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 3�Z o ��►Gof�s M i�� �20�0 . <br /> PID: ' <br /> DESCRIPTION OF WORK: N�c�/ f�c-5. <br /> ZO.�tI�ti G REVIEW BY: ,^ DATE APPROVED: S-2g�03 <br /> BUII.,DING REVIEW BY: DATE APPROVED: s��. -03 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLA��T REVIEW Yes � No SEWER CONNECTTOI�' <br /> STATE SURCHARGE Yes � No WATERCONNECTTON <br /> INVESTIGATION FEE � Yes No�� PARK FEE <br /> SAC s��-�� A,�w Yes No_� SITEINSPEG"ITON <br /> Number of SAC-Units OTHER (specify) <br /> ZONING CH�CK LIST Zoning District: _ <br /> Fire Department: Post Office: School District: � <br /> Lot Area: Sq�.ft. 21��ly� Acres y.999 � Width ►2rzx�v�A+e Depth _ . <br /> Survey Submitted: Yes � No Date of Survey: 11•2z-o Z <br /> Proposed Setbacks: � <br /> Front(�aicc): 135' Right Side: '1 Z•� � <br /> , <br /> Reaz(Sc�eet}: �-13� � Left Side: f oo' <br /> Adjacent Structures: /V l� Wetland: f�o' ± <br /> Building Height: Def. Hgt. 3�' Peak Hgt. 3G.S <br /> Lot Coverage: NIA <br /> Gradina: Staff Approval Date: S- 2 q-� By: o'�� - Council Approval Date: -- <br /> Septic: Staff Approval Date: By: <br /> Zoning File: # — Resolution: # ^ Resolution Date: <br /> Shoreland District: N� <br /> Avg. Setback: Bluff Setback: I.ot Coverage: <br /> Existin; Proposed <br /> Hazdcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hazdcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS(in house): <br /> 7 <br />