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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: ,'j/ Li.-',LLv / S t <br /> PID: <br /> DESCRIPTION OF WORK: (f _. G, I r^,y c�c <br /> -------------ZONING REVIEW BY: % 1,, DATE APPROVED: C._ 2 - <br /> BUILDING REVIEW BY: ! ` C DATE APPROVED: L - <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ,, ' No <br /> PLAN REVIEW Yes ;,� No SEWER CONNECTION <br /> STATE SURCHARGE c Yes No WA 1"rK 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: (34 -/6' <br /> Fire Department: L,CA. L.+l : Post Office: J (Alai-LI School District: O:P-t <br /> Lot Area: Sq.ft. No c.i4Arirey Acres — Width -- Depth '-- <br /> Survey Submitted: Yes No 041 Date of Survey: <br /> tv%ei.k c ,i'.z v --ti-k5 i= eea K c1r.4- <br /> Proposed Setbacks: <br /> Front (Lake): r 3�' t Right Side: <br /> Rear(Street): t:% + Left Side: J?) /- <br /> Adjacent Structures: t'1' t- Wetland: /v i 64 <br /> Building Height: Def. Hgt. O. 16- Peak Hgt. — <br /> Lot Coverage: 0.IL <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: Lot Coverage: <br /> • <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): No Pe„v4",. v' c <br /> 7-72 ( A F '7_ int Fra Peterm <br /> _1 26 <br />