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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: (02.S C7t_6 Ceti S Qi\+f (?o Isc,O <br /> PID: Z ;. - ( 1 - 2.3 3 i 000 2 6...-); I( r 1i3,44vs9 tr),n-4 too- C .C3 iry/ w•0 <br /> DESCRIPTION OF WORK: TCS 4(L )4 <br /> ZONING REVIEW BY: � YQw. DATE APPROVED: /2.-3i-gc. <br /> BUILDING REVIEW BY: U Cf2.444,-._ DATE APPROVED: Z-3/-9 47 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes t/' No <br /> PLAN REVIEW Yes ✓ No SEWER CONNECTION <br /> STATE SURCHARGE Yes t---- No WATER CONNECTION <br /> INVESTIGATION-FEE Yes No L PARK FEE <br /> SAC Yes r./ No SITEINSPECTION <br /> Number of SAC Units f Z. OTHER (specify) <br /> ZONING CHECK LIST Zoning District: Q(Z-( <br /> Fire Department: (t fie)04-ICC, Post Office: C01..Wrtc42, School District: ORoNO <br /> Lot Area: Sq.ft. j j, 6 i7, ( Acres -j.t{ Width `( 5€.'Y`(5—A Depth 39 7.0 T <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: <br /> Front (L-alae): (GO' 6-A T` Right Side: 50' (N0 <br /> Rear (Street): so` wc5-r Left Side: j 2$0( 6) <br /> Adjacent Structures: N(0 Wetland: 60 -i-- <br /> Building Height: Def. Hgt. Peak Hgt. 32,1 <br /> Lot Coverage: J /0- <br /> Grading: Staff Approval Date: I Z -3'- 5 1, By: — Council Approval Date: <br /> Septic: Staff Approval Date: AIM- By: <br /> Zoning File: # 21 Z$ Resolution: # Resolution Date: OC r 2if-(no <br /> Shoreland District: <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): <br /> 26 <br />