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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: /5 S S p izonv c-3 OAV S ,OR• <br /> . PID: - --- -- - <br /> DESCRIPTION OF WORK: poor ' <br /> ZONL tG REVIEW BY{ c' U Jo (QA.,...„_ DATE APPROVED: 6 -/2- 03 <br /> BUILDENG REVIEW BY: DATE APPROVED; <br /> FEES TO BE CHARG:D: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Yes ,/ No SEWER CONNECTION <br /> STATE SURCHARGE Yes ✓ No WA1• RCONNECTION <br /> INVESTIGATION FEE - Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC-Units 1 OTHER(specify) <br /> ZONING CHECK LIST Zoning District: <br /> Fire Department: • Post Office: School District: • <br /> • <br /> Lot Area: Sq.ft. Acres • Width Depth <br /> Survey Submitted: Yes1 x NoDate of Survey: on, 1:I Uz <br /> Proposed Setbacks: 1 <br /> Front(Lake): iI5- 1 Right Side: 2.4.0 ±• <br /> Rear(Street): t i t + <br /> Left Side: 7 o ' <br /> Adjacent Structures: SO' Wetland: it o' -r <br /> Building Height: Def. Hgt. — Peak Hgt. — <br /> Lot Coverage: r'/A <br /> Grading: Staff Approval Dat : — By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # — Resolution: # Resolution Date: • <br /> Shoreland District: N 0 <br /> Avg. Setback: Bluff Setback: Lot Coverage: <br /> Existing Proposed <br /> Hardcover: 0-4 . <br /> 75- 50' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS (in house): <br /> 7 <br />