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` CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS ORLEGAL: 3H6o ��zG+ c,�.�. <br /> PID: <br /> DESCRIPTION OF WORK: O�.—U� t- f�=S����� <br /> ZO�PIG REV�`V BY: _ DATE APPROVED: �o- y-�`t <br /> BUILDI1i 1G REV�`V BY: DATE APPROVED; �� -�1-o� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERI�IIT Yes ✓ No <br /> PLA1�I REVIEW Yes �' No SEWE.R CO�INECITON <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 /> Z01�1I�1G CHE.CK LIST Zoaing Districr. <br /> Fire Department: Post Office: School Distric[: <br /> Loc Area: Sq.ft. Acres Widch Depth <br /> Survey Submitted: Yes � No Date of Survey: �(–/`d -� 3 <br /> Proposed Setbacks: <br /> Fronc(Lake): I 20� � Right Side: 3 3� + <br /> Rear (Street): ��� �` Left Side: (�Z; '= <br /> Adjacent Structures: q��aci+�� �Ve[land: N/R <br /> Building Hei�ht: Def. Hgt. N C1� Pea�:Hgt. — <br /> Lot Coverage: �V -C - <br /> Grading: Staff Approval Date: �v r . � By: Council Approval Date: <br /> Septic: Staff Approval Date: — BY� <br /> Zoning File: # —' Resolution: � Resolution Date: <br /> Shoreland Distric[: <br /> Avg. Setback: �,�� Bluff Setback: �1(/� Loc Coverage: n!•C-- <br /> Ezistin� Proposed <br /> b <br /> Hazdcover: 0-75' <br /> 75-250' �v t� G f�. __ d <br /> 250-SQO' <br /> 500-1000' <br /> Hazdcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS (in house): <br /> 7 <br />