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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 3 O�5 C�SC.o (�o�� r rLo/� <br /> PID: <br /> DESCRIPTION OF WORK: oa 1 <br /> Z0�1G REV�`V BY: DATE APPROVED: s � 3 -o S <br /> BUII�DING REVIE�V BY: DATE APPROVED: �- 3_ a� <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 WATERCONNECTION <br /> INVESTIGATION FEE Yes No �/ PARK FEE <br /> SAC Yes No � SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ---------------------------------------------------------------------------------------------------------------------- <br /> ZOi�1I�1G CH�CK LIST Zoning District: <br /> Fire Deparcment: Post O�ce: School District: <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes :9C No Date of Survey: pe,r K ti�� <br /> Proposed Setbacks: <br /> �e$t (Lake): �1Z'{' Right Side: ►5� <br /> �esr (Street): � �g0' '= Left Side: ►5 ' <br /> Ad;acent Structures: ��' Wetland: N l,/1 <br /> Building HeiGht: Def. Hgt. /�! IA Peak Hgt. — <br /> Lot Covera;e: �!�C., <br /> Grading: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # — Resolution: # Resolution Date: <br /> Shoreland District: T e� <br /> Avg. Setback: p.�c Bluff Setback: rr /A Lot Covera�e: N�L <br /> Ezisting Proposed <br /> Hazdcover: 0-75' <br /> 75-250' �J• 3 <br /> 2�0-500' z g•9 <br /> 500-1000' <br /> Hardcover Variance Required: Yes No r�-- Date of Council Approval: <br /> REI�iA.RKS (in house): <br /> 7 <br />