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. � <br /> CHECK OFF LIST FOR ISSUANCE OF PER1ti1ITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: �3�d (�r �°�'`r` �� <br /> PID: <br /> DESCRIPTION OF �t�ORK: t'1�A�s-r-�'�L. �l.ct��D c--Z— <br /> --------------------------------------------------------------------------------------------------- <br /> ZOtVI�YG RE VIE tV B Y: I _ DATE APPRO VED: <br /> B UILDIiVG.REVIE t�B Y: DA TE APPRO vED: //- i s"- n�( <br /> ------------------------------- <br /> FEES TO BE CHARGED: �%tisc. Fees Calciciczted By: <br /> PERttifIT Yes r/' No <br /> PLANRET�IE4V Yes � �Vo SEYVER GO�Vt�IECTION <br /> STfITE SURCHARGE Yes �/ �vo tiVATER CO�Wt ECTIO�V <br /> I[VVESTIGATXON FEE Yes No PARK FEE <br /> Sf1C Yes tVo SITE NSPECTIO�V <br /> Nttmber of SAC Utzits OTHER (specify) <br /> -------------------------------------------------------------------------------------------------- <br /> ZO[YI[YG CHECh'LIST Zorii,ig Discricc: <br /> Fi,•e Depat•hnerrt: Post O �ce: Schoo!Dish•ict: �_.. <br /> Lot.�trea: Sq.f't. Acres �Yidth Depth <br /> Su�vey Su6��iitted: Yes No DRte of Scuvey: <br /> Proposed Setbacks: <br /> Front(Lake): Rigl:t ide: <br /> Rear(Sh•eet): Lef Side: <br /> Adjacent Structiu•es: Y�etland: <br /> Buildi�Tg Height: Def. Hgt. Pec�k Kgt. <br /> Lot Coverage: � <br /> Grading: Staff Approva!Date: By: Council Approval Date: <br /> Septic: StaffAPProval Dc�te: BY� <br /> Zoriirig File: # Resolutiori: # Resolc�tion Date: <br /> Shoreland Disd•ict: <br /> Avg. Setbnck: Bluf)`'Setbc�ck: LotCoverage: <br /> Existing Proposed <br /> Hardcover: 0-7.i' <br /> 75-�50' <br /> 250-500' <br /> 500-1000' <br /> Kar•dcover �ariance Required: Yes No Date of Couiacil Approval: <br /> RE111ARKS(in liotcse): <br /> 31 <br />