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CHECK OFF LIST FOR ISSUANCE OF PERMITS � � <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 3s�S s i x-n� /�v� ,�v <br /> PID: <br /> DESCRIPTION OF WORK: oo � <br /> _ __ __ _ ---------------------------------------------------- . ------- =- -- <br /> ZO�1P1G REV�W BY: ��,,�..� DATE APPROVED• 6- z �Y <br /> BUII.D�G REV�W BY: (�„� DATE APPROVED; � . Z. �Y <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PER1l�iIT Yes � No <br /> PLAi�1 REVIEW Yes �/ No SEWER CONNECITON <br /> STATE SURCHARGE Yes � No WATERCONNECITON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZONING CH�CK LIST Zoning District: /Uo C�tr�,^�C,,C <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: � � <br /> Front (Lake): KUd r Righc Side: /?� � <br /> Rear (Street): Z��� + Left Side: `t o � +' <br /> Adjacent Structures: 1 b� �Vetland: N (� <br /> Building Hei�ht: Def. Hgt. — Peak Hgt. — <br /> Lot Coverage: iJ � �/�- <br /> Grading: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # — Resolution: # Resolution Date: <br /> Shoreland District: (�"� <br /> Avg. Setback: Bluff Setback: L,ot 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 /> 7 <br />