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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 00 oc., T9t.-- a3• <br /> go <br /> PID: <br /> DESCRIPTION OF WORK: s -t <7 <br /> ZONING REVIEW BY: , P/„ DATE APPROVED: t-• to- o <br /> c)cBUILDING REVIEW BY: ,Q DATE APPROVED: 10• I° -0 3 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓. No <br /> PLAN REVIEW Yes No r/ SEWER CONNECTION <br /> STATE SURCHARGE Yes s— No WATER CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC-Units OTHER (specify) <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 pi_ No Date of Survey: Di•r f=i 1.-G <br /> Proposed Setbacks: <br /> Front Gala.): 3t6G f Right Side: 90c) ' 4 5 <br /> Rear(Street): 3 X) Left Side: -SO ' -`` ^I <br /> Adjacent Structures: 7& ' -I— Wetland: <br /> Building Height: Def. Hgt. a .(L Peak Hgt. <br /> Lot Coverage: n1 ( /), <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File: # Resolution: # Resolution Date: <br /> Shoreland District: 2 5 <br /> Avg. Setbac : 0. rL Bluff Setback: AI / Lot Coverage: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' (.7,K <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No j7 Date of Council Approval: <br /> REMARKS('m house): <br /> 7 <br />