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,j • CHECK OFF LIST FOR ISSUANCE OF PER�'IITS <br /> FOR OFFICE USE ONLY - <br /> ADDRESSORLEGAL: '��t5 tx�lA� s�r- , . <br /> PID: <br /> DESCRIPTION OF WORK: (U�� t'?x`� - <br /> ZO�'G RE`'IEW BY: DAT'E APPROVED: t- s•ao <br /> BUII.DPs iG REVIEW BY: � DATE APPROVED: r-5-o 0 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes ✓' No <br /> pL?,ri REV�W Yes �/' No SEtiVER CO�fNECTION <br /> STATE SURCHARGE Yes � No tiVATERCONNECTTON <br /> INVESTIGATION FEE Yes No � Pt1RK FEE <br /> SAC Yes �_ No_�/ STTEINSPECTION <br /> Number of SAC-Units OTHER (specify) <br /> ________--- --- -- <br /> ZO�Zti'G CHE.CK LIST Zoning Dis�ict: �ra•r� . <br /> Fire Department: (e n,c, (A iC,� Post O�ce: (,�o�� School District: ot�N D <br /> Lot Area: Sq.fc. 7?�,b 3?.7 Acres 1•��O � Width 2'i'3.t _ �4✓L Depth z 1� <br /> Survey Submitted: Yes�_ No Date of Survey: I Z-�d�9 S <br /> Proposed Setbacks: � <br /> Front(�e): l 35 Right Side: � 7 2 3 � <br /> Rear(Street): �1•"t.' Left Side: 5�1�`3 <br /> Adjacent Structures: ��P� Wetland: �.!/�4 <br /> Buildin;Height: Def. Hgc. Z5•S Pea�:Hgt. T7. � <br /> Lot Coveraae: o'k ' <br /> Grading: Staff Approval Date: 1 - 5 • c9 � By: � Council Approval Date: '" <br /> Septic: Staff Approval Date: 5�e.,-.�� By: <br /> Zoning File: # 2�f�1 Z `. Resolution: # Z a? Resolution Date: /��3•O�S <br /> Shoreland District: 11�b <br /> Avg. Setback: Bluff Setback: L,fltCoverage: <br /> � Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hazdcover Variance Required: Yes No Date of Council Approval: <br /> RED�ARKS ('in house): <br /> 7 <br />