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CHECK OFF LIST FOR ISSUANCE OF PERtiIITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL:26y3 H020'J0LAnc.NPID. <br /> DESCRIPTIO\ OF WORK: <br /> Z O\P�'G RE-v= BY: DATE APPROVED: 2-.12.-5 c. <br /> B'U'ILDL\G REti-IEtiV BY: DATE APPROVED: z -i 2-Gtf. <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes �� No <br /> PLAN REVIEW Yes 1--, No SEtiVFR CONNECTION <br /> STATE SURCHARGE Yes .4-- No WATER CONNECTION <br /> INVESTIGATION FEE Yes No e'— PARK FEE <br /> SAC -Yes No SITE INSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONLNG CHECK LIST Zoning District: 2R-%Z Shoreland District: A& <br /> Fire Department. L,yt ,_e.A�t.0 `Post Office: (,o&rc, School District: 0.2-cDNV <br /> Lot Area: Sq.ft. Acres Z Width 3115±_ Depth <br /> Survey Submitted: Yes A No Date of Survev: 2- 6 "Ci <br /> Proposed Setbacks: <br /> Front (Lake): ( (vS Right Side: //S•9 2 t <br /> Rear (Street): `)j Left Side: <br /> Adjacent Structures: Al//9 Wetland: <br /> Building Height: Def. Hgt. 7-o1 Peak Hgt. 3 {•-.S,- <br /> Avg. Setback: Bluff Setback: Lot Coverage: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> N 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> Grading: Staff Approval Date: 2 I Z,-i(,, By: Council Approval Date: <br /> Septic: Staff ApprovalDate: 2-� "CIS Bv: W <br /> Zonin; File: # r Resoiudon• Resolution Date: <br /> RM,V ARKS (in house): v e L A�.rts A,(JP I A c11 <br /> Lb R v e_w A�u C.cs c.4�� , �A+ o s (,,,AJ- <br /> 26 <br /> aA J26 <br />