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� � CHECK OFF LIST FOR ISSUANCE OF PERMITS „ <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 31 d (.�pc�' s'� � <br /> • PID: <br /> DESCRIPTION OF WORK: (� , �,q.�,o�e��- 5 8�� sti .�- <br /> ZO��TG REV�W BY: DATE APPROVED: !v- i 5- �! <br /> BUII..DING REVIEW BY: DATE APPROVED; I o-i 5 -�� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PER1vIIT Yes ✓� No � <br /> PLAl�t REVIEW Yes �' No SEWER CONNECTTON <br /> STATE SURCHARGE Yes ✓No WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No STTEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZONIlVG CH�CK LIST Zoning District: QQ-1l� <br /> Fire Department: Post Office: School District: � <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes� No Date of Survey: onti r=�k, <br /> Proposed Setbacks: <br /> Front(Lake): ZOo� + Right Side: l�5� � <br /> Rear(Street): l b� Left Side: (Iv` <br /> Adjacent Structures: 9 S� Wetland: N /r4 <br /> Building Height: Def. Hgt. i 5 � Peak Hgt. 1�� <br /> Lot Coverage: �• K <br /> Grading: Staff Approval Date: i c� •� –v 1 By: � Council Approval Date: <br /> Septic: Staff Approval Date: �" By: <br /> Zoning File: # — Resolution: # Resolution Date: <br /> Shoreland District: N � <br /> Avg. Setback: Bluff Setback: Lot Coverage: <br /> Existing Proposed <br /> Hazdcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hazdcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS(in house): <br /> 7 <br />