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CHECK OFF LIST FOR ISSUANCE OF PERII�IITS <br /> _ FOR OFFICE USE ONLY � <br /> ADDRESS ORLEGAL: Zuc�� S�co�4RW oo,�s �2 . <br /> PID: <br /> DESCRIPTION OF WORK: � <br /> . <br /> ZO�'G REVIEW BY: DATE APPROVED: `t•fo -d�' <br /> BUII.DP�tG REV��BY: DATE APPROVID: q-v �n� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> pERMIT Yes �/ No :. <br /> PLAN REVIEW Yes � No SEWER CONNECTION <br /> STATE SURCHARGE Yes �/ No WATERCONNEC'ITON <br /> IN�VESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTTON <br /> Number of SAC�Units OTHER (specify) <br /> ZO�iL�1G CH�CK LIST Zoning Districr. R-�A � <br /> Fire Deparcment: I,�•� " Post Office: [,�,,.��(,.A� School Districr. c���v� � <br /> Lot Area: Sq.ft. N o G H�►nr Actes � Width Depth <br /> Survey Submitted: Yes_� No Date of Survey: - �N '''�� <br /> Proposed Setbacks: <br /> Front(Lake): � 2�0` t Right Side: I`�l�� }' <br /> Rear(Street): �b� � Left Side: q 0` '* <br /> Adjacent Structures: A�'t't4c.N+cr.� Wetland: N(� . <br /> Buildirig Height: Def. H;t. /�l 1�4 Peal:Hgt. <br /> Lot Covera�e: <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File: # Resolution: # Resolution Date: . <br /> Shoreland Disuict: <br /> N.� Avg. Setback: BlufF Setback: I.otCoverage: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> ?SO-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Dace of Council Approval: <br /> REVLA.RKS (in house): <br /> 7 <br />