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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: t/Z�' f-}un�T��2 Pi4 s s <br /> PID: <br /> DESCRIPTION OF WORK: CN�(j,q.,ycQ �iVo,v � „,,,�-� <br /> ZONING REV�W BY: DATE APPROVED: �o�2.2- .S'7--- <br /> BUII..DING REVIEW BY: N i�- DATE APPROVED: <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes ✓� No <br /> PLAN REVIEW Yes �- No SEWER CONNECITON <br /> STATE SUR�HARG� Yes � No WATER CONNECITON <br /> INVESTIGAT'ION-FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZOi�TIl�1G CHECK LIST Zon.ing District: �R •t t3 <br /> Fire Department: Post O�ce: School District: <br /> Lot Area: Sq.fr. Acres Wid[h Depth <br /> Survey Submitted: Yes No Date of Survey: <br /> roposed Setbacks: � <br /> Front (Lake): S Right Side: <br /> Rear(Street): Left Side: <br /> �(� Adjacent Structures: Wetland: <br /> Building Height: Def. Hgt. Peak Hgt. <br /> Lot Coverage: <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoaing File: # Resolution: # Resolution Date: - <br /> Shoreland DisL-ict: <br /> Avg. Setback: Biuff Setback: Lot Coverage: <br /> - Eusting Proposed <br /> Hardcover: 0-75' <br /> 75-250' . . <br /> 250-500' . <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS (in house): <br /> • 26 <br />