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CHECB OFF LIST FOR ISSUANCE OF PERMITS <br /> � � FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: K/9 5 H/6H w oo/� ��� . <br /> PID: -- --- -- - <br /> DESCRIPTION OF WORK: G.�►�cc Ac'cdss sn9,2.s �►� u�s�os�.N G <br /> ZO�Tni TG REVIEW BY: DATE APPROVED: -r-��-0 3 <br /> BUII.DING REY�W BY. DATE APPROVED: -�-i�-a3 . <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PER�I�IIT Yes _� No <br /> PLAlV REVIEW Yes ,/ No SEWER COrfNECTION <br /> STATE SURCHARGE Yes �/ No WATE�CONNECTION <br /> INVESTIGATION FEE � Yes No ✓ PARK FEE <br /> SAC Yes No � SIT'EINSPECITON <br /> Number of SAC�Units OTHER(specify) <br /> ZONING CI�CK LIST Zoning District: [_/1.-i� <br /> Fire Department: � Post Office: School District: • � � <br /> Lot Area: Sq.ft. Acres . 9 ' Width Depth <br /> Survey Submitted: Yes No Date of Survey: <br /> Progosed Setbacks: � . � ' <br /> Front(Lake): Right Side: <br /> Reaz(Street): Left Side: G� K <br /> Adjacent Structures: — �Yetland: '` . <br /> Building Height: Def. Hgt. _._----- Peak Hgt. --- <br /> Lot Coverage: <br /> Grading: Staff Approval Date: ---- By: Council Approval Date: b -S •03 <br /> Sepcic: Staff Approval Date: �-- By: <br /> Zoning File: # d3•-z.feq`�l Resolution: # 99 Y Resolution Date: (o •�J•. 03 <br /> Shoreland District: y,ps <br /> Avg. Setback ni��a B1uffSetback: �IVR2��ru3 I.otCoverage: NiA <br /> Existina Proposed <br /> Hazdcover: 0-75' <br /> 75-250' N,� <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS(in house): <br /> 7 <br />