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f CHECK OFF LIST FOR ISSUr�\TCE OF PERMI'rS <br /> . • FOR OFFICE USE ONLY <br /> " ADDRESS ORLEGAL: '-r3`f S No 2Ttr �H�/� /.�lt � <br /> PID: - <br /> DESCRIPTION OF WORK: ��Tp►cltc,�'J (��4d1�6C� <br /> ZO.�tI�Ti G REVIEW BY: DATE APPROVED: r-,-25- 0 3 <br /> BITII�DI'�i TG REV�W BY: DATE APPROVED; �i'-Z�t - 03 <br /> FEES TO BE CHARGED: Misc. Fee� Calculated By: <br /> PERMIT Yes � No <br /> PLAN REVIEW Yes v No S:EWER CONNECTTON <br /> STATE SURCHARGE Yes !/ No WATER CONNECTTON <br /> INVESTIGATION FEE � Yes No PARK FEE <br /> SAC Yes No STTEINSPECTTON <br /> Number of SAC�Units OTHER(specify) <br /> ZONING CH�CB LIST Zoning District: . <br /> Fire Department: Post Office: School District: • <br /> Lot Area: Sq:ft. Acres � �drh Depth <br /> Survey Submitted: Yes_�� No Da:e of Survey: /� • �4 -O 3 <br /> Proposed Setbacks: � <br /> Front(I.ake): /5 � Right Side: /7 � � <br /> Rear Street : � <br /> ( ) ?32 � Left Side: �.� <br /> Adjacent Structures: `�,3 � Wetland: �/ I � <br /> Building Height: Def. Hgt. �•�� Peal:HgL <br /> Lot Coverage: 0�(� <br /> Grading: Staff Approval Date: •- By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # � Resolution:# Resolution Date: � <br /> Shoreland District: <br /> Avg. Setback: �./t 1�} Bluff Setback: !� •(� Lot Coverage: �' <br /> Existing Proposed <br /> Hazdcover: 0-75' <br /> 75-250' � <br /> 250-500' ZS.5 <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> ''�IARBS(in house): _ <br /> 7 <br />