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, <br /> ' ' �HEC�K OFF i,IST FOR ISSUANCE O]E' PE��IITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: � �G,t-• 'S�+��L�� <br /> PID: inc�._ ��Shv�c, �� HaaE-�ci <br /> DESCRg''TION OF WORK: r+4-I�h�a � � � <br /> __---- ___--__-------�----���--------/--------------------- �,�'" 2 <br /> ZOV�1G REVLE`V BY: � DAT'E APPROVED: ' 2Z <br /> BUII�DING REVIE�V BY: DAT`E.APPROVED: lo- Z6 - o k, <br /> FEES TO BE CHARGEA: / Misc. Fees Calculated By: <br /> p�g�T Yes c/ No <br /> PLAN REVIE`V � Yes � No SEWER CONNECTION <br /> STATE SURCHARGE Yes � No `VATERCONNECTION <br /> INVESTIGATION FEE Yes No � PARK FEE <br /> SAC Yes No _� SITEINSPECTTON <br /> Number of SAC�Units OTHER (specify) <br /> ------------ ---------------------------------------- <br /> ZON'1.1�tG CHE.CK. LIST Zoning Districr. L� � !� , <br /> Fire Department: Post Office: School District: <br /> � Widch Depth <br /> L,ot Area: Sq.ft. �' �J Acres <br /> Survey Submi[ted: Yes t/ No Date of Survey: S � �� " �� <br /> Proposed Setbacks: n�,�'�V1 / ' '� . <br /> Froat(Lake); �J � -�tt-Side: ([J ` <br /> r So� <br /> Rear(Stree[): �eft Side: � L <br /> � �'1 �t <br /> Ad;zcent S�NCn1£CS: �, 3 � � Wetland: <br /> Buildin� Hei�ht: Def. Hgt, t7.� Peal:Hgt. — <br /> Lot Coverage: 2 I��� C Z�%v�� <br /> Grading: Staff Approval Date: By: Council Approval Date: � <br /> Septic: Staff Approval Dace: /v �Y� _.�t�t'' <br /> Zoai.ng File: (#�4� � l � Resolution: � Resolution Da[e: �ti !z Q� <br /> Shoreland District: ✓ <br /> Avg. Setback: -- Bluff Setback: --- L.otCoverage: <br /> E�istin Proposed <br /> � S cc�,�w n,l K �' <br /> Hardcover: 0-7�' �(a� ��-='� Pt�hc. :.�n�� r�...lL <br /> �.� (u<;�i���tx., Z <br /> 7�-zso� 2 7 y �-F'.�,�,,, _� �^ b b� �e,vv�c�c��( <br /> 2�0-500' Y,:,�k) <br /> 500-1000' <br /> Hardcover Variance Required: Yes � No Dacz of Council Approval: � � <br /> F lL4RKS (in house): G s� Lcsn �tcl�' �� �.l�.�Q c� <br /> � .. � �., � � . C � cu: V'f�� <br />