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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: Z6► S W CS CA-,c A ycr-77 <br /> PID: <br /> DESCRIPTION OF WORK: /400 i a• <br /> ZONING REVIEW BY: DATE APPROVED: /2 V .0 2 <br /> BUILDING REVIEW BY: ( ( DATE APPROVED: , L 0 z <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes — No <br /> PLAN REVIEW Yes i/ No SEWER CONNECTION <br /> STATE SURCHARGE Yes (/ No WA IER 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: <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes K No Date of Survey: 4/. 2.3. O Z_ <br /> Proposed Setbacks: <br /> Front(Lake): oie Right Side: ( C S� } <br /> Rear(Street): Q 7 Left Side: 21. 5 <br /> Adjacent Structures: ATrxlC-1ft Wetland: //4t <br /> Building Height: Def. Hgt. 0 •te.. Peak Hgt. <br /> Lot Coverage: 0.(L <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # — Resolution: # Resolution Date: <br /> Shoreland District: 'y-ey Lot Coverage: - <br /> Avg. Setback: N (r Bluff Setback: H/4 <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' z Y.(' 5- 2 y.9 <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS (in house): <br /> 7 qi IhilSeirrt,k ue 1 imPL3. <br />