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r CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: y11 cr DA- - 2cE-1 <br /> PID: <br /> DESCRIPTION OF WORK: a)E P(Acc r c� pL-GtL5 <br /> ___ <br /> ZONING REVIEW BY: DATE APPROVED: y- -�- o c. <br /> BUILDING REVIEW BY: DATE APPROVED: gyp- 7- o <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes i/ 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 SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONLNG CHECK LIST Zoning District: <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes No Date of Survey: O 'rt u: 1-1 b 5 6 <br /> Proposed Setbacks: <br /> Front (Lake): Right Side: <br /> Rear (Street): Left Side: N 0 CN�4^�e �.V FOS <br /> Adjacent Structures: Wetland: nJ 1 A <br /> Building Height: Def. Hgt. 0, Peak Hgt. — <br /> Lot Coverage: <br /> Grading: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: _ By: <br /> Zoning File: # — Resolution: # Resolution Date: <br /> Shoreland District: ), Lot Coverage: <br /> Avg. Setba 01— V,. An�w,k-Bluff Setback: ��� <br /> k2 rC�� <br /> Ezistina Proposed <br /> a <br /> Hardcover: 0-75' <br /> 75-250' M0 Cif a <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No _ cX Date of Council Approval: <br /> RENL4RKS (in house): <br />