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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRFSS OR LEGAL: I 3(O (L�.� �o�Nz � <br /> PID• <br /> DESCRII'TION OF WORK: L�rnN i4�n�..-Yt�a 1�� <br /> ZO�PTG REVIEW BY: DATE APPROVED: I� �Z6 �L <br /> BUII.DING REVIEW BY: ��,� DATE APPROVED; <br /> w'f'�o G �- _ <br /> FEES TO BE CHARGED: r'��'1�'i�c. Fees Cal� culat�d By: <br /> PERMIT Yes a� No <br /> PLAN REVIEW Yes No SEWER CONNECTTON <br /> STATE SURCHARGE Yes No WATERCONNECTTON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No STfEINSPECITON <br /> Number of SAC�Units OTHER (specify) <br /> ZONING CH�CK 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: <br /> Proposed Setbacks: ` �j�Y✓l � �Q ((VI t� �J ' <br /> Front(Lake): Right Side: <br /> � r'/lAvr. �t ��e5 <br /> Rear(Sueet): Left Side: <br /> Adjacent Structures: -� Wedand: �' <br /> Building Height: Def. Hgt. Peak Hgt. �' <br /> Lot Coverage: `-' <br /> Grading: Staff Approval Date: -- By: Council Approval Date: <br /> Septic: Staff Approval Date: � By: <br /> Zoning File: # ^� Resolution: # Resolution Date: <br /> Shoreland Disuict: r-- <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 Wariance Required: Yes No Date of Council Approval: <br /> REMARKS(in house): <br /> 7 <br />