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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: z(-d 5 W M-ZA -A (3LV V) <br /> PID: <br /> DESCRIPTION OF WORK: 5T 6AAg Q <br /> ZONING REVIEW BY: DATE APPROVED: ✓o-7 1-()5 <br /> BUILDr�;G REVIEW BY: DATE APPROVED: t o-?-�-os <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 CONNECTION <br /> INVESTIGATION FEE Yes No ✓ PARK FEE <br /> SAC Yes No ✓ SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ----------------—----------------------------------------------------------------------------------------------------- <br /> ZONLNG CHECK LIST Zoning District: <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes K No Date of Survey: <br /> Proposed Setbacks: <br /> Front(Lake): Right Side: 36to t <br /> Rear(Street): Z-SD Left Sidq: Z9-0 + <br /> Adjacent Structures: I o' Wetland: N) j4 <br /> Building Height: Def. Hat. o-� Peak Hgt. — <br /> Lot Coverage: nt <br /> Grading: Staff Approval Date: 10-Zl- By:,_. L Council Approval Date: <br /> Septic: Staff Approval Date: N By: <br /> Zoning File: # S-3t(5 Resolution: # Resolution Date: /p- /V- 65' <br /> Shoreland District: N o <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 Variance Required: Yes No Date of Council Approval: <br /> REMARKS (in house): <br />