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a <br /> CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 1160 X VZ <br /> PID: <br /> DESCRIPTION OF WORK: <br /> ----------------------------------------------------------------------------------------------------------------------- <br /> ZONING REVIEW BY: , DATE APPROVED: <br /> BUILDING REVIEW BY: 02, DATE APPROVED: <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 J J PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING CHECK 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: Z-- L-S V C oN F,tz� <br /> Proposed Setbacks: <br /> , <br /> Front -7 Right Side: 1 04 t ± <br /> Rear (Stream: std�'� Left Side: 236 t <br /> Adjacent Structures: Wetland: too -- <br /> Building Height: Def. Hgt. O.V� Peak Hgt. d.V- <br /> Lot Coverage: N 1 A <br /> Grading: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # -- Resolution: # Resolution Date: <br /> Shoreland District: N b <br /> Avg. Setback: Bluff Setback: Lot Coverage: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> * REMARKS (in house): -Nk, Woav- Ggl l� d.¢..„,.,-►— — 4r <br /> SFf-CCT-/LuUQe-J6 --Vnbf W14-6ry !'L- -nue <br /> 7 <br />