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1 � � <br /> ' � • C�ECK OFF LIST FOR ISSUANCE OF PERMITS <br /> � FOR OFFICE USE ONLY . <br /> ADDRESS OR LEGAL: Z-� e� S K�.v��� �2��1�' <br /> PID: <br /> DESCRIPTION OF ORK: iA�!J v��T i �rv <br /> ZO�TING REV�W BIY: DATE APPROVED: _�/- 3 U -0 O <br /> BIJILDING REVIEW BY: DATE APPROVED: �/- 30 -W <br /> FEES TO BE CHAR�ED: Misc. Fees Calculated By: <br /> PERNIIT Yes �/ No <br /> pLAl�i REVIEW Yes � No SEWER CONNECTION <br /> STATE SURCHARGE Yes � No WATER CONNECITON <br /> INVESTIGATION FF� Yes No PARK FEE <br /> SAC Yes No STTEINSPECTTON <br /> Number of SAC Units OTHER (specify) <br /> --- - .+---- ---------------------------------- _-- --__ <br /> ZOr'�1G CHECK L�.ST zoning Discricc: R2-�� <br /> Fire Department: V�1c.0 Post OfFice: (�oni C�(�IAIC.� School District: p1ZON c� <br /> Lot Area: Sq.ft. 12,�ys' � Acres (•bl Wid[h I 22e���-�� Depth <br /> Survey Submitted: Yes X No Date of Survey: '''{'b'"'Z <br /> Proposed Setbacks: <br /> Front(Lake): 120� i' Right Side: Sb� t <br /> Reaz(Street): 35a� �' Left Side: �'t C) � � <br /> Adjacent Structures: AZ"hA�►��=-� Wetland: V�J I A <br /> Buildin� Height: Def. Hgk. �• k- Peal:Hgt. <br /> Lot Covera�e: b.k� <br /> Grading: Staff Approval�ate: � By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # — Resolution: # Resolution Date: . . <br /> Shoreland District: I�I O <br /> Av�. Setback: Bluff Secback: Lot Covenge: <br /> Eusting Proposed <br /> Hazdcover: 0-75' <br /> ,75-250' <br /> 250-500' <br /> 'S00-1000' <br /> � <br /> Hardcover Varia�ce Required: Yes No Date of Council Approval: <br /> I <br /> RE�RI�S (in hous�): <br /> 7 <br /> i <br />