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. .�. <br /> CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> � FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: �l S L v C� C��N C )2���C <br /> PID: <br /> DESCRIPTION OF WORK: �P p bL� <br /> ----------------------------------------- --,-,,/-�-�-------------------------------------------------------�_--_-------- <br /> ZONING REVIE� BY: � Uu►�-- DATE APPROVED: / 4� �i� <br /> BUILDING REVIEW BY: h/�� DATE APPROVED: <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes � No <br /> PLAN REVIEW Yes r/ No SEWER CONNECTION <br /> STATE SURCHARGE Yes �/ No WATER CONNECT'ION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING CHECK LIST Zoning District: �/L ' �� <br /> Fire Department: /►1/}P�P�+� Post Off ce: �M.C�UrV,� School District: �,L: �5��11�4 <br /> Lot Area: Sq.ft. Nu �i�`�i'Z Acres � Width � Depth — <br /> Survey Submitted: Yes ;x No Date of Survey: C7N c=�� <br /> Proposed Setbacks: <br /> Front (�.�j: �{.� f/�' Right Side: � � � <br /> Rear (�eeE): f��, � Left Side: i �Cl� '�` <br /> Adjacent Structures: S�j ' Wetland: /`� 1�' <br /> Building Height: Def. Hgt. ti �/� Peak Hgt. <br /> Lot Coverage: <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: By� <br /> y�r Zoning File: # Resolution: # Resolution Date: <br /> � <br /> Shoreland District: <br /> Avg. Setback: Bluff Setback: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-lOOO' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS (in house): <br /> 10 <br />