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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 3 S�i S �►y P l.�c�: <br /> PID: <br /> DESCRIPTION OF WORK: r{�p� n on1 <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING REVIE� BY: � DATE APPROVED: ,5- '7- �? <br /> BUILDING REVIEW BY: DATE APPROVED: 5-7-5 7 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes � No <br /> PLAN REVIEW Yes ✓" No SEWER CONNECTION <br /> STATE SURCHARGE Yes ✓ No WATER CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING CHECK LIST Zoning District: G.R-/C <br /> Fire Department: yhoUN�p Post Offce: wAyZ,4 tva- School District: ;�;�5�•�n1=�� <br /> Lot Area: Sq.ft. �Vp cN�QAcres Width Depth <br /> Survey Submitted: Yes�_ No Date of Survey: '3' Z?- � � <br /> Proposed Setbacks: <br /> �t (Lake): t OZ� '� Right Side: !35 � 5 <br /> B.�ar (Street): ��•%' '� Left Side: N�i'� <br /> Adjacent Structures: A��r�ect Wetland: N��" <br /> Building Height: Def. Hgt. p, �L Peak Hgt. p,��, <br /> Lot Coverage: c9�k-- <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> �U� Septic: Staff Approval Date: By: <br /> Zoning File: # Resolution: # Resolution Date: <br /> Shoreland District: ��5 <br /> Avg. Setback: jJ'i/-�- Bluff Setback: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' �.� 2`1.S <br /> 250-500' <br /> SOO-lOOO' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS (in house): <br /> 10 <br />