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� <br /> CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: y00 ��q-�=' Sr� <br /> PID: <br /> DESCRIPTION OF WORK: / <br /> ZONING REVIEW BY: DAT`E APPROVED: (- 3 v •o> <br /> BUILDING REVIEW BY: DAT`E APPROVED: 6 • 3c�-o� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes �/ No <br /> pL�,N REVIEW Yes �/' No SEWER CONNECITON <br /> STATE SURCHARGE Yes —� No WATERCONNECTION <br /> INVESTIGATION FEE Yes No ✓ PARK FEE <br /> SAC Yes No v SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ------------------------------------------------------------------------------------------------------------------- <br /> ZO��Il�1G CHECK LIST zoning District: <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres Wid�h Depth <br /> Survey Submitted: Yes� No Date of Survey: aN t=i v� <br /> Proposed Setbacks: � <br /> Front (i�ce): ( Z 3 �' S Right Side: �3 �:- <br /> Rear (Ss�eet): b6� 'r � Left Side: i Z 1 �.1 <br /> Adjacent Structures: ((.S Wetland: o•/C <br /> Building Height: Def. Hgt. — Peal:Hgt. — <br /> Lot Covera�e: — <br /> Grading: Staff Approval Date: � By: Council Approval Date: <br /> Septic: S[aff Approval Date: �- By: <br /> Zoning File: # � Resolution: # Resolution Date: . . <br /> Shoreland District: � <br /> Av�. Setback: i..��- Bluff Setback: r(� I.otCoverage: �//p� <br /> Existin, Proposed <br /> Hardcover: 0-75' <br /> 7�-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> RElv1ARKS (in house): ,. <br /> 7 <br />