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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESSORLEGAL: �Hz� 4/�L��:2 Pra��� <br /> PID: <br /> DESCRIPTION OF WORK: L.o„e,,t,,.,o �,v <br /> ZOrT�1i G REVIE`V BY: DATE APPROVED: S -z6 •05 <br /> BUILDING REVIE`V BY: DATE APPROVED: s zc� • oS' <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓� No <br /> PLAN REVIEW Yes �/ No SEWER C0�INECI'ION <br /> STATE SURCHARGE Yes �/ No WATERCONNECTION <br /> INVESTIGATION FEE Yes No ✓ PARK FEE <br /> SAC Yes No �/ SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ----------------------------------------------------------------------------------------------------------------------- <br /> Z01�1IYG CH�CK LIST zoning Districc: C.rz-�L <br /> Fire Department: Pos[Office: School Dis[rict: <br /> Lot Area: Sq.ft. �i�tg0 Acres . Z'Z Wid[h ,5"D' Depth <br /> Survey Submitted: Yes _ c� No Date of Survey: 3-�b-oS <br /> Proposed Setbacks: <br /> Front (Lake): �� � * Right Side: ^3� "� <br /> Rear (Street): SB�� } Lef[Side: I u' `3�� <br /> Ad;acent Structures: �-r-r7�,c l�� Wetland: /V I r/� <br /> Buildin; Heighc: Def. Hgt. C�.k Peal:Hgt. — <br /> Lot Covera�e: r,75 7 � �; <br /> Grading: S[aff Approval Date: N /,� By: — Council Approval Date: — <br /> Septic: Staff Approval Date: ^/r,.y By: — <br /> Zonin; F:le: # o s-3�� e Resolution: # Resolution Date: S-Z3 -a 5 <br /> Shoreland District: ���e5 <br /> Av�. Setback: c�•� Bluff Setback: nl 1� L.oc Coverage: � �5� <br /> ExistinQ Proposed <br /> b <br /> Hardcover: 0-75' 3•� s•S <br /> 7�-2�0' _Sv.Z `TS-5 <br /> 2�0-500' <br /> 500-100fl' <br /> Hardcover Variance Required: Yes �t _ No Date of Council Approval: S"-2 3-�S <br /> RE1�IA_R�iS (in house): <br /> � <br />