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CHECb OFF LIST FOR LSSU�iCE OF PERMITS <br /> • � FOR OFFICE USE ONLY <br /> �DDRESS OR LEGAI.: i �, �;::,. } :,r� •:_:( , �'.� t- <br /> PID: <br /> DESCRIPT'ION OF WORK: h �� � �,, t i < � �;� � _ � �� � : '`� <br /> ------------ --------- . <br /> , �- -- <br /> ZOi�tING REVIEW BY: � DATE APPROVID: �o�Z.�-�S <br /> BUII.DING REVIEtiV BY: DATE APPROVID: �c� - _ 6 -5 S <br /> - -------------------------- <br /> FEES TO BE CHARGED: :�1isc. Fees Calculated By: <br /> PERMIT Yes � No <br /> PL��t REVIE� Yes � No SEWER CONNECTION <br /> STATE SURCHARGE Yes ✓ No WATER COi�NECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITE I'�i tSPECTION <br /> Number of SAC Units OTHER (specify) �M__MY <br /> ------------ <br /> ---------------- <br /> ZOivT�1G CHECK LIST Zoning District: RR-<<3 Shoreland District : <br /> ,� Post Office: w f+ti—�-� School District: �n-o+�o <br /> Fire Department: (.� �rZhn�t <br /> G/f� e Acres — Width — Depth — <br /> Lot Area: Sq.ft. NU � <br /> Survey Submitted: Yes � <br /> ,yo Date of Survey: pti1 �=��-� <br /> Proposed Se[backs: <br /> Front (L.ake): S�� Righc Side: N I t� <br /> Rear (Street): t 30� = Le2t Side: ►�� <br /> :�djacent Structures: l� <br /> � -� Wetland: A�I A� <br /> BuIlding Heieht: Def. Hgt. � 3 Peak Hgt. �b •5 <br /> ?.vg. Setback: Bluff Setback: Lot Coverage: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Reauired: Yes �v'o Date of Council Approval: <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> �� Septic: Staff Approval Date: By' <br /> Zoning File: � Resolution: i# Resolution Date: <br /> RE�'��AR�.S (� h0use): <br />