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, � , CHECIi OFF LIST FOR ISSUA.��'CE OF PERlI'IITS <br /> _ FOR OFFICE USE ONLY . � . <br /> ADDRESS OR LEGAL: z�� g 5�.�A�y�,�n d f2�o�0 <br /> PID: <br /> DESCRZP7�4N OF�ORK: ��C�c �?�P tJ�c.� <br /> . <br /> ZONI:\'G REY�ti�BY: DATE APPROVED: t�-Z2-c�o <br /> BUII,D�'G REY�tiV BY: . D4TE APPROYED; /z•iz-�n� <br /> FEES TO BE CH.4RGED: biisc. Fees Calculated By: <br /> pEgMIT Yes ,/ No :. <br /> PLAN REVIEW Yes �/ No SEW�CONNEG"TION - <br /> STATE SURCHARGE Yes �/ No WATF.RCONNECITON <br /> II�iVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC•Unics OTHER (specify) <br /> ZO��LIIG CH�CK LIST Zonin�Districc: LR -/C. . <br /> Fire Departmenr. m ov+v /� Post Office:.. w�tiv�r� School District: w e STc��N K.� - <br /> Lot Area: Sq.fr. '�.`�b3 Z Acres . �, t � Widch Depch <br /> Surve;Subritted: Yes_� No Date of Survey: ,1u-�t�'no <br /> Propvsed Setbacks: � � <br /> Frnnt(La.ke): 9S Right Side: �Z� + <br /> I�eer(Screet): 1�s Left Side: 1�3�(o <br /> Adjacent Structures: 14�c:'►'� �Vetland: N�A � • <br /> Buildin� Height: Def. H�t. /� //� Peal:Hgt. <br /> Loc Covera�e: O• �� <br /> Gradin�: Stafi Approval Date: /✓/A gy: — Council Approval Date: — <br /> Septic: Staff Approval Dace: N /R By: <br /> Zoaing File: � 2 6� 3 Resolution: n Resolution Date: /Z-I l-v d . <br /> Shoreland Disuict: �,es <br /> Av;. Setback: _�iq/Z� r4w,c,c Blufi Setback: N /� Lot Cocera�e: _ <br /> E���a Proposed <br /> Hardcover: 0?5' _� �� . <br /> 75-250' �o•t <br /> ?SO-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes_� No Da�e of Couacil Approval: 12- 11-OD <br /> gE1�iARb',S(in house): <br /> 7 <br />