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CHECK OFF LIST FOR ISSUAINCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: ,�2.So wA <br /> -FR cx,;;.� PID: <br /> DESCRIPTIO\ OF WORK: ��� <br /> ZONZtiG RE`�j` BY: ��-- DATE APPROVED: ��-�c:-��; <br /> - - - - y CS�k <br /> BUII.DL\G RE«`V BY: DAA APPROVED: <br /> FEES TO BE CH.-kRGED: No Misc. Fees Calculated By: <br /> PERMIT Yes No <br /> PLAN REVIEW Yes SEVER CONNECTION <br /> WATER CONNECTION <br /> STATE SURCHARGE Yes L/ No <br /> No PARK FEE <br /> INVESTIGATION FEE Yes SITE INSPECTION <br /> SAC Yes No <br /> OTHER (specify) <br /> Number of SAC Units <br /> ---------------------------- <br /> ���'�- I✓F Shoreland District : �J <br /> ZO`D G CHECK LIST Zoning District: <br /> Fire Department: N ( L <br /> Post Office: — School District: <br /> Lot Area: Sq.fr. <br /> Acres Z 7 Width Depth <br /> Survey Submitted: Yes <br /> No Date of Survey: <br /> Proposed Setbacks: } <br /> Front (L-ake): .`row Right Side: <br /> Rear (Street): Z wi 4— Left Side: <br /> Adjacent Structures: i 7 t= Wetland: 6- <br /> Building Height: Det Hgt. V <br /> Peak Hgt. <br /> Avg. Setback: -- Bluff Setback: Lot Coverage: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' rLt <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No K_ Date of Council Approval: <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File: Resolution: 17 <br /> Resolution Date: S <br /> RE�l1ARK-S (in house): <br /> 26 <br />