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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: � �j O �x �A i z.vv� �?_�/a'✓� <br /> PID: <br /> DESCRIPTION OF WORK: �Q =� <br /> - ---- ----- - ------_--_------------------------------------ <br /> ZO�II�IG REVIE`V BY: � _ DATE APPROVED: �i-�o • o y <br /> BLTII,DP�1G REVIE`V BY• DATE APPROVED; � -� � -�Y <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERi1�1IT Yes ✓ No <br /> PLP.N REVIEW Yes �/ No SEWER CONNECTION <br /> STATE SURCHARGE Yes i/ No WA'TER CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZONI�IG CH�CK LIST Zoning District: <br /> Fire Departmen[: Post Office: School Districr. � <br /> Loc Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes ,�C No Date of Survey: o,.r , <br /> Proposed Setbacks: , <br /> Front (Lake): 9 u � Righ[Side: �� ± <br /> Rear (Street): 300� � Left Side: �S 1 � <br /> Adjacent Structures: �4Tr►4c.i�rc:� `Ve[land: � <br /> Building Hei;b.t: Def. Hgt. — Peak Hgt. <br /> Loc Coveraoe: '^ <br /> Gradino: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: � BY� <br /> Zoning File: # Resolution: f� Resolutioa Date: <br /> Shoreland District: N� � <br /> Avg. Se[back: �.IC [eBluff Se[back: L.otCoverage: �� <br /> EzistinQ Proposed <br /> 0 <br /> Hazdcover: 0-75' �`(,L <br /> 75-250' <br /> 250-500' <br /> 500-1d00' <br /> Hazdcover Variance Required: Yes No� Date of Council Approval: <br /> REMARKS (in house): <br /> 7 <br />