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t <br /> ' CHE�JK OFF i�IST FOR ISSU.ANCE OF �E�1�fITS <br /> FOR OFFTCE U5E ONLY� . <br /> ADDRESS OIt LEGAL: 3p60 �J KT'�I (?.e>.q-r� �� - <br /> PID: <br /> AESCRZPTIO�1'OF WQRK: l3AsCM�� l�'�N�sy <br /> _---�----- --------- ____ <br /> ----------------------------------- <br /> ZONI�IG REV7EW BY: . N ( A DATE APPP�OVED: <br /> SUILDING REVII�tiV BY: DATE APPROVED; y-2s -o ?. <br /> FEES TO BE CHARGED: / Misc. Fees Catculated By: <br /> pgg�T Yes �/ No <br /> PLAN REVIEW � Yes —� No SE�VER CO�tNECTION <br /> STATE SURCHARGE Yes —� No WATERCONNECTION <br /> INVESTIGATION FEE Yes No �– Pf1.RK FEE <br /> SAC Yes No� STTEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> 2pYIt�I'G CH�CK. LIST zoning Districc: N U �' �f-�-r�fG� , <br /> V � <br /> Fire Department: Post Office: School District: • ' <br /> L,ot Area: Sq.ft. Acres � ' th Depth <br /> Survey Submitted:� Yes No te of Survey: <br /> Proposed Setbacks: � . ; <br /> Front(Lake): Ri�t Side: . <br /> Rear (Street): Lefc Side: <br /> Adjacent Structures: Wetl <br /> Buil�lin�Height: Def. Hgt, Peak Hgt. <br /> Lot Coveraoe: <br /> Gradino: Scaff Approval Date: By: Council Approval Date: ' <br /> Septic: Staff Approval Date: � `� � a BY� 1�1.._' <br /> ZoainJ File: n Resolution: n Resolutioa Date: <br /> Shoreland District: <br /> Avg. Setback: Bluff Setback: I.ot Coverage; <br /> Eusting Proposed <br /> Hardcover: 0-75' <br /> 75-25Q' <br /> 2�0-500' <br /> 500-1600' <br /> �Iardcover Va:iance Requi;ed: Yes �'o Dace of Council Approv�; <br /> F.E1L�.RI�S (in house): <br />