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' '� CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> .. • <br /> ' FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: _ 363 o C.,1 v tv�+G S 1'� /�P <br /> PID: <br /> DESCRIPTION OF WORK: (���.� <br /> ZONING REVIEW BY: DATE APPROVED: � `�'�i <br /> BUILDING REVIEW BY: DATE APPROVED: $ - 2.�-�c <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 WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTTON <br /> Number of SAC Units OTHER (specify) <br /> ZONL�TG CHECK LIST Zoning District: C,�-(C= ( <br /> Fire Department: /�O��I� Post Office: W ary-�-�,�g. School District: W,�5��,/_. <br /> Lot Area: Sq.ft. /�d Glf�rvpp Acres Width Depth <br /> Survey Submitted: Yes ot No Date of Survey: oN Ftu.' <br /> Proposed Setbacks: <br /> Front(Lake): 2y' * Right Side: y Z� r <br /> Rear(Street): �S 3� r Left Side: p <br /> Adjacent Structures: A-r-np c �=,r� Wetland: �1/} <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 /> Zoning File: # ' Resolution: /f Resolution Date: <br /> Shoreland District: /`1v <br /> Avg. Setback: Bluff Setback: Lot Coverage: <br /> Existing Proposed <br /> Hardcover: 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 />