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• CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> � FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: Z�O5 in,4Q� /2�06{ � <br /> PID: <br /> DESCRIPTION OF WORK: �o�` � <br /> ZO.�tI�i tG REVIEW BY: � --�-N--- DATE APPROVED: B'�—0 3 <br /> BUII..DING REVIEW BY: DATE APPROVID; v - 3 -s3 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes _�/' No <br /> PLAN REVIEW Yes � No SEWER COriNECTTON <br /> STATE SURCHARGE Yes �/ No WATERCONNECITON <br /> INVESTIGATION FEE � Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZONING CH�CK LIST Zoning Districr. . <br /> Fire Depaztment: Post Office: School District: • <br /> Lot Area: Sq�.ft. B 2,0 E�' Acres 7•4�$ � Width �/U1,c.'�u u.� Depth <br /> Survey Submitted: Yes x No Date of Survey: z�-I-n z <br /> Proposed Setbacks: � <br /> Frest(Lake): �i I ' � Right Side: bv� f <br /> Rear(Street): � $0� ± Left Side: 9�� + <br /> Adjacent Structures: ;o` Wetlaad: iv I� <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: # b�3-?J�q� Resolution: # Resolution Date: <br /> Shoreland Disuict: �e,P� <br /> Avg. Setback: v,4�c�„a,�,c.� Bluff Setback: /(� _ LAt Coverage: N//� <br /> E���g Proposed <br /> Hazdcover: 0-75' <br /> 75-250' <br /> 250-500' Z y•5�. <br /> 500-1000' <br /> Hudcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS(in house): <br /> 7 <br />