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CHECK OFF i,IST FOR ISSUANCE OF PERMITS <br /> • FOR OFFICE USE ONLY <br /> • ADDRESS OR LEGAL: � 3 c�� S p 2�.,c.�: �c•q c,�. <br /> PID: <br /> DESCRIPTION OF WORK: L.q �� /�cc�ss 5�►�2 <br /> ZO�G REVIE`V BY: � DATE APPROVED: Z- � 3- a b <br /> EUILDING REVIEti'Y ZY. DATE APPROVED; Z - t 3-o;b <br /> FEES TO BE CHA.RGED: Misc. Fees Calculated By: <br /> PERMIT Yes � No <br /> PLAN REVIEW � Yes ,/ No SEWER CONNEC'TION <br /> STATE SURCHARGE Yes �/ No WATERCONNECTTON <br /> �INVESTIGATION FEE Yes � No � PARK FEE <br /> �e�.z� SAC Yes No �/ SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ----------------------------------_—_----------------------------------------------------------------------------- <br /> ZONI�IG CHE.CK LIST Zoning District: <br /> Fire Depar[ment: Post O�ce: School District: <br /> L.ot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes ;X No Date of Survey: p hs �=i(� <br /> Proposed Setbacks` <br /> Fron[ (Lake): Right Side: <br /> Rear (Street): Left Side: <br /> Adjacent Structures; Wetland: <br /> Building Heioht: Def. Hgt. Peal:Hgt. <br /> Lot Coveraje: <br /> � oR Grading: Staff Approval Date: By: Council Approval Date: <br /> �• <br /> N,� Sepcic: Scaff Approval Date: By: <br /> Zoning File: !# Resolution: # Resolution Date: <br /> Shoreland District: <br /> Av�. Setback: Bluff Setback: L.ot Covera;e: <br /> Eusting Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 2�0-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Dace of Council Approval: <br /> .E1�L4RKS (in house): <br /> -�— SnA��. C.oNs rrwcx�� t,���-+o•.,; (1Q•.w�� r - <br /> � <br />