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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY - <br /> ADDRESS OR LEGAL: 351 O �v o tz�-t 5�w� �J R . �: � . <br /> ' PID: -- --- -- - <br /> DESCRIPTION OF WORK: ,'�,�-y�,�a�Z,.' <br /> ZO�.�tI�i TG REVIEW BY: (Q�,�.._ � � DATE APPROVED: G-ic -�3 <br /> BUILDI�i 1G REVIEW BY: DATE APPROVED; � -/6-0 3� . <br /> FEES TO BE CHARGED: � Misc. Fees Calculated By: <br /> PER11iIIT Yes ✓ No <br /> PLAi�1 REVIEW Yes �/' No SEWER COrfNECTTON <br /> STATE SURCHARGE Yes_/ No WATERCONNECITON <br /> INVESTIGATION FEE � Yes No PARK FEE <br /> SAC Yes No SIT`EINSPECTTON <br /> Number of SAC�Units OTHER (specify) <br /> ZO�TING CI�CK LIST Zoning District: �v a C�.�-,syvs�C <br /> Fire Department: � Post Office: School District: • � <br /> Lot Area: Sq.ft. Acres ' Width Depth <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: � � � <br /> Front(Lake): Right Side: <br /> Reaz(Street): Left Side: <br /> Adjacent Structures: �Ve land: , <br /> Building Height: Def. Hgt. Pe �Hgt. <br /> Lot Coverage: <br /> Grading: Staff Approval Date: y: Council Approval Date: <br /> Septic: Scaff Approval Date: <br /> Zoning File: # Resolution: # Resolution Date: � <br /> Shoreland District: <br /> Avg. Setback: Bluff Setbac : Lot Coverage: <br /> Ezisting 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 /> RENL!�.RKS(in house): <br /> 7 � <br />