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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> � FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 3�Z 5 nf a2 nf syy��►►�u2 p� <br /> PID: <br /> DESCRIPTION OF WORK: C�•�s��e v��rvir.�, -�-�o /�va�-�. c3R�s rr.v� <br /> ZONING REVIEW BY: ..._. DATE APPROVED: 7-�n-o z. <br /> BUILDING REVIEW BY: DATE APPROVED: --�_ ,o-oZ <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Y�s �' No <br /> PLAN REVIEW Yes _� No SEWER CONNECI'ION <br /> STATE SURCHARGE Yes v No WATER CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTTON <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECK LIST Zoning District: <br /> Fire Department: Past Office: School District: � <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes_Q� No Date of Survey: p►.� �-�� <br /> Proposed Setbacks: <br /> Front(�): �7 � t Right Side: �l�{� -� <br /> Rear(SE�eet): LIH� t Left Side: -7 6' = <br /> Adjacent Structures: Zo' + Wetland: .�lq <br /> Building Height: Def. Hgt. p .�C Peak Hgt. e9�(� <br /> Lot Coverage: N� C�-+�� <br /> Grading: Staff Approval Date: !-- By: Council Approval Date: <br /> Septic: Staff Approval Date: -- By: <br /> Zoning File: # � Resolution: # Resolution Date: <br /> Shoreland District: y.Cf <br /> Avg. Setback: ^r�/d Bluff Setback: /��/-� L.otCoverage: N•C. <br /> Existing Proposed <br /> Hardcover: 0-75' �p <br /> 75-250' �� G(��7' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Vaziance Required: Yes No � Date of Council Approval: <br /> REMARKS(in house): <br /> 7 <br />