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• � CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: (f,�l`'i 1/� �rVN ETt�N�� !-���µC�rvrO C/�,-e <br /> PID: <br /> DESCRIPTION OF WORK: ��LK <br /> ZONING REVIEW BY: DATE APPROVED: S-� ��S <br /> BUII.DING REVIEW BY: DATE APPROVED: s=�- �� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes �/ No <br /> PLAN REVIEW Yes �/' No SEWER CONNECTION <br /> STATE SURCHARGE Yes _� No WATER CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECK LIST Zoning District: L�2 •/� <br /> Fire Department: (,�N T Post Office: ���� School District: ��iv� �ic•C� <br /> Lot Area: Sq.ft. rUo Acres — Width � Depth — <br /> Survey Submitted: Yes�C,_ No Date of Survey: o�.r F i� <br /> Proposed Setbacks: <br /> Front(�eke): �S� Right Side: G 2� � <br /> Rear(St�eet): 9�$� Left Side: y0� + <br /> Adjacent Structures: A�'T�c�� Wetland: N(A <br /> Building Height: Def. Hgt. /\( �/� Peak Hgt. <br /> Lot Coverage: — <br /> Grading: Staff Approval Date: �— By: — Council Approval Date: — <br /> Septic: Staff Approval Date: -- By: — <br /> Zoning File: # � Resolution: # — Resolution Date: —" <br /> Shoreland District: �,.p5 <br /> Avg: Setback �� /,a- Bluff Setback: �/(/s LotCoverage: — <br /> Existing Proposed <br /> Hazdcover: 0-75' <br /> 75-250' Q� <br /> 250-500' <br /> 500-1000' <br /> Hazdcover Vaziance Required: Yes No o� Date of Council Approval: <br /> REMARKS(in house): <br /> 7 <br />