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�CHE�JK OFF i,IST FOR ISSU.ANCE �F �ERMITS <br /> FOR OFFICE USE ONLY . . <br /> ADDRESS ORLEGAL: 354Z 5�10Ctr c ��� �2 <br /> PID: <br /> DESCRIPT'IO�i OF WORK: LC�sE -S��A c.t r�—��o�- <br /> ZO�TG REVTE�4V BY: ------I 1'� _w_ DA.TE APPROVED: . <br /> $U]ZDIN'G REVTEtiV BY: DA.TE APPROVED; � -6-aco <br /> FEES TO BE CHARGED:� Misc. Fees Calculated By: <br /> pEg�T Yes ,/ No <br /> PLAN REVTEtiV ' � Yes � No SEti�ER CONNECTTON <br /> STATE SURCHARGE Yes _� No �VATERCONNECTION <br /> INVESTICrATION FEE Yes No _� PARK FEE <br /> SAC Yes No S�'I'EINSPECTTON <br /> Number of SAC�Uruts OTHER (sgecify) <br /> ZO�(I�IG CHE.CK LIST Zoaing Districr. /`�J C � . <br /> Fire Department: Post OfFice: School District: • ' <br /> Lot Area: Sq.ft. Acres � Width Depch <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: . : <br /> Front(Lake): Right S'de: . <br /> Rear(Street): Left ide: <br /> Adjacent Scructures: �Vetiand: <br /> Builclin�Heipht: Def. Hgt. Peak Hgt. <br /> Lot Coveraae: <br /> Gradino: Staff Approval Date: By: Council Approval Date: ' <br /> Septic: Staff Approval Date: �Y� <br /> ZoainJ File: � Resolution: # Resolution Date: <br /> Shoreland District: <br /> Av�. Setback: Bluff Setba k: L.o[Covera�e: <br /> Ecistiao Proposed <br /> Hardcover: 0-75' <br /> 75-25Q' <br /> 2�0-500' <br /> 500-1000' <br /> Ela:dco�er Va�iance Requi;ed: Yes No Date ef Co�ncil Approvzl: <br /> � <br /> F.E:��L�iRhS (in house)• <br />