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� CHECK OFF LIST FOR ISSUANCE OF PERNIITS <br /> FOR OFFICE USE Oi�TLY • <br /> ADDRESS OR LEGAL: 3� � � (J� �l!��1GsTv� <br /> PID: <br /> DESCRIPTION OF WORK: ���,,� (?�� <br /> ZOVI�IG REVIE`V BY: D�TE APPROVED: /r- z 2 -S`� <br /> BUILDL�IG REVIEW BY: DATE APPROVED; (( -LZ �5 <br /> FEES TO B� CHARGED: NSisc. Fees Calculated By: <br /> PERMIT Yes _� No <br /> pLAN REVIEW Yes �_ No SEWER CONNEC'TION <br /> STATE SURCHARGE Yes ,� No tiVATERCONNEG"ITON n,AJ c�� -`�3�.<^; <br /> INVESTIGATION FEE Yes No PARK FEE �'*3�'"`"* '�� <br /> SAC Yes � No STTEINSPECTTON <br /> Number of SAC�Units 1 OTHER (specify) <br /> Z0��1G CIi�CK LIST zoning District: LR -��-� <br /> Fire Department: w�,o�J,�✓� Post Office: c A1 A y-ch t� School Discricc: w e s r0 n1 rch <br /> Lot Area: Sq.ft. I 2,�� Acres .(�2 g Width Z�� Depth (o`'� <br /> Survey Submitted: Yes L No Date of Survey: O-OS•9 <br /> Proposed Setbacks: <br /> Fron[(La.ke): � 1 Ri�ht Side: Q <br /> Rear (Street): (� Left Side: � <br /> Adjacent Struccures: O � Wetland: /�1 � U� <br /> Building Heioht: Def. Hgc. (�.��- Peal:Hgt. <br /> Lot Coverage: N � ✓� � <br /> Grading: Staff Approval Date: D ,l�C By: � Council Approval Date: <br /> Septic: Staff Approval Date: /v � � By: <br /> Zoaing File: � Resolution: �# Resolution Date: <br /> Shoreland District: <br /> Av�. Setback: Bluff Setback: L.otCovera�e: <br /> �,� ' Ezisting Proposed <br /> Hardcover: 0-75' <br /> 7�-250' <br /> 250-500' <br /> 500-1000' <br /> Har�cover Variance Required: Yes No Date of Council Approval: <br /> REti'IpiR�iS (in house): <br /> 7 <br />