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� �HEC3K OFF i,IST FOR ISSUANCE OF �ERMITS <br /> FOR OFFICE USE ONLY . <br /> AADRESS OR LEGAL: Zo�,b G� �`?,o�a✓� �� N � <br /> PTD: <br /> DESCR�'TION OF WORK: D i TI d.� /k:����- <br /> ZOYNG REV3E�V BY: ---- --��- W� �6 DAT'E APPROVED: � -1 b •0 7 <br /> SUILDING REVIEtiY BY: DATE.APPROVED; � -(6 -�7. <br /> FEES TO BE C�-IARGED:^ � Misc. Fees Calculated By: Pe� v►��P� � �-� <br /> PERMIT Yes _�� No <br /> PLAN REVIEtiV � � Yes �/No SE`'VER COYNECTION C <br /> STATE SURCHARGE Yes v No WATERCONNECTTON d <br /> INVESTIGATION FEE Yes / No � �PARK FEE � <br /> SAC Yes !/ No S,ITEINSPECTION O <br /> Number of SAC�Units � s„�. n�r G�,�.� � CITHER (specify) �o <br /> ---------------------------------- ---------�- b-�g�0 6--------------------------------------------------- <br /> ZONItvG CI�CK LIST Zoning District: . <br /> Fire Department: ��i� Post OfFice: Go.�Lt-iu� School Discrict: o2a�a� <br /> Lot Area; Sq.ft. Acres � Widch Depth <br /> Survey Submitted: Yes X No Date of Survey: j-1'�- OS <br /> Proposed Setbacks: , . . <br /> Front(Lake): �yy � '� Riaht Side: ' 23g =' <br /> Reaz(Street): �(2� '� Left Side: l°l�� � <br /> Adjacent Structures: (�� � Wetland: N I r4 <br /> Buildin;Heipht: Def. Hgt, b�\� Peal:Hgc. —' <br /> Lot Coveraoe: N 1 A <br /> Gradino: Staff Approvat Date: �-01-0� gy; 'f'oN�ouncil Approval Date: -- ' <br /> Septic: Staff Approval Date: N �14 BY� <br /> Zoain� File: �# 05•3 f 4� Resolution: 1f SYl t Resolution Date: 1 • �' C�� <br /> Shoreland District: l7 <br /> Avg. Setback: Bluff Setback: L.ot Covera;e: <br /> E�.isting Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 2�0-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Da�e of Council Approval: <br /> RE��L4RKS (in house): <br />