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a. �, <br /> ' CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> ` FOR OFFICE USE ONLY . <br /> ` ADDRESS OR LEGAL: Z`�5 sH,A�a���u o o� 2oa� <br /> PID: <br /> DESCRIPTION OF WORK: _(qpq 6� /�0�0�n o�.1 <br /> ZO�TING REVIEW BY: DATE APPROVED: <br /> BUILDING REV�W BY: 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 CONNECTTON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No STTEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZO��tG CHECK LIST zoning Districc: <br /> Fire Department: Post OfFice: School District: <br /> Lot Area: Sq.ft. Acres Widch Depth <br /> Survey Submitted: Yes ✓ No Date of Survey: 3-'�-°3 <br /> Proposed Setbacks: <br /> Fr�eut(Lake): I y'���' Right Side: Zo•� <br /> R�ear(Street): ��I� � Left Side: tS1 <br /> Adjacent Structures: ��,4.,J Wetland: — <br /> Building Height: Def. Hgt. p.�c. Peak Hgt. o•�� <br /> Lot Coveraae: '� /O.c�q <br /> Grading: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: " By: <br /> Zoning File: # 3-2�8'I� Resolution: # Resolution Date: Y�'Z`i- °� . . <br /> Shoreland District: v�5 <br /> Avg. Setback: n�/ia Bluff Setback: N /.� L.ot Coverage: <br /> Existing Proposed <br /> Hardcover: 0-75' , � .GH. <br /> 75-250' z1.t'/+-- -z 3.9 g <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No oC Date of Council Approval: <br /> RENIARKS(in house): _ _ <br /> 7 <br />