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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: /7✓ t= rvw -- .:. <br /> PID: <br /> DESCRIPTION OF WORK: Poo 1 • <br /> ZONING REVIEW BY: . ))2. DATE APPROVED: (0 -s - ffS <br /> BUILDING REVIEW BY: �6 $‘' <br /> ATE APPROVED: (0-S-5(8FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Yes L - No SEWER CONNECTION <br /> STATE SURCHARGE Yes L— No WATER CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECK LIST Zoning District: (. (Z - I p, <br /> Fire Department: (oN(0(,A Post Office: (pn16 (Ate,- School District: ORS' C) <br /> Lot Area: Sq.ft. /VU G/1-Afky,t Acres Width Depth <br /> Survey Submitted: Yes p� No Date of Survey: 0..i .4/k¢ S-g - <br /> Proposed Setbacks: <br /> Front (Lake): `tO` -±2 Right Side: GO t <br /> Rear (Street): 22-3 f Left Side: I`{V s <br /> Adjacent Structures: 10 ' Wetland: (,-1(A <br /> Building Height: Def. Hgt. /.I (A Peak Hgt. — <br /> Lot Coverage: /`f ( <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File: # Resolution: # Resolution Date: <br /> yv.`'/�- Shoreland District: <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 /> ' MARKS (in house): <br /> 7 <br />