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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY ' � <br /> y . <br /> ADDRESS OR LEGAL: 3�� � �(10f�1�Y a rro/k; �02 <br /> PID: <br /> DFSCRIPTION OF WORK: FR o�ur �NT� snoP A� s�� Po� <br /> ZO�TING REVIEW BY: DATE APPROVED: �o.z�.-•z. <br /> BUII.DING REVIEW BY: DATE APPROVED; c c� -z�.� �z <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes _� No <br /> PLAN REVIEW Yes JC No SEWER CONNECTION <br /> STATE SURCHARGE Yes _,G No WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZONING CHECS LIST Zoning District: . <br /> Fire Department: Post Office: School District: � <br /> Lot Area: Sq�.ft. Acres � Width Depth <br /> Survey Submitted: Yes� No Date of Survey: �n•z�• o'L__ <br /> Proposed Setbacks: 9"''P p,"ti. .sT-o p ��,.�; <br /> Front(i�e�): QO Iy0 Right Side: �t� <br /> Reaz(Street): �36 "19 Left Side: y 1 0 <br /> FeoniOhn�.�(i� <br /> Adjacent Structures: 1 l' F,,,Now.r,�,� Wetland: N 1 A <br /> Building Height: Def. Hgt. d•Sc- Peak Hgt. 0�k <br /> Lot Coverage: 10.2 <br /> Grading: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: !t — Resolution: # Resolution Date: <br /> Shoreland District: y Q5 <br /> Avg. Setback: /v/A- Bluff Setback: rv 1✓fi Lot Coverage: r o•2 <br /> Eusting Proposed <br /> Hazdcover: 0-75' <br /> 75-250' <br /> 250-500' i}�.Z �4•` <br /> 500-1000' <br /> Hazdcover Variance Required: Yes No�_ Date of Council Approval: <br /> REMARKS(in house): <br /> 7 <br />