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� CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> ., FOR OFFICE USE ONLY <br /> ADI�RESS OR LEGAL: �(�O /V a �3 R o w N R.•o,a,� <br /> PID: <br /> DESCRIP"I'ION OF WORK: (�o 01 <br /> ZOi�TING REVIEW BY: 4. �_ DATE APPROVED: G�Z y�63 <br /> BUII,DING REVIEW BY: DATE APPROVED: Z •Z y-v3 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> pLAN REVIEW Yes c/ No SEWER CONNECTTON <br /> STATE SURCHARGE Yes �� No WATERCONNECITON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ------------------------------------------------------------------------------------------------------------------- <br /> ZOrT�1i G CHECK LIST zoning Disuicc: <br /> Fire Depar[ment: Post Office: School District: <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes�_ No Date of Survey: biv l=�1�.: <br /> Proposed Setbacks: <br /> Front (Lake): 2 Z S � Right Side: f b 3� � <br /> Rear (Street): i do' fi Left Side: � 5Z' �' <br /> Adjacent Structures: ZS' t Wetland: N/✓a <br /> Building Height: Def. Hat. /J I p Peak Hgt. — <br /> Lo[ Covera�e: — <br /> Gradin�: Staff Approval Date: —' By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: � — Resolution: !# Resolution Date: <br /> Shoreland District: rv�, <br /> Avg. Setback: Bluff Setback: Lo[Coverage: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-2�0' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> RENIARKS (in house): <br /> 7 <br />