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CHECK OFF LIST FOR ISSUANCE OF PERl�1ITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: Y05� QAysi Or �R� <br /> PID: <br /> DESCRIPTION OF WORK: �,-�t-�o'.� (,,42A�� <br /> ZO.vI�Ii G REVIE`V BY: DATE APPROVED: � -Z3 -oy <br /> BUII.,DI11G REVIE`V BY: DATE A.PPROVED; �g- z� -o�c <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PER�vIIT Yes ./' No <br /> PLAl�t REVIEW Yes � No SEWER CONNECITON <br /> STATE SURCHARGE Yes � No WATF.RCONNECTION <br /> INVESTIGATION FEE Yes I�To PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZO�YI��iG CIiE.CK LIST Zonino Districr. R Q- I A <br /> Fire Department: Post O�ce: School District: <br /> Lot Area: Sq.ft. Acres � 2.� Wid[h Depth <br /> Survey Submitted: Yes �/ No Date of Survey: <br /> Proposed Setbacks: <br /> Fron[ (Lake): �9.} � Right Side: � 256 <br /> i <br /> Rear (Street): q$0� fi Left Side: � �A�•Z <br /> Adjaceac Struc[ures: � � `Vetland: i 5a`+ <br /> Building Hei;hc: Def. Hgt. !� � Pea.�Hgt. 2� � <br /> Lo[Covera�e: f✓�a� <br /> Grading: Staff Approval Date: '- By: Council Approval Date: <br /> Sep[ic: Staff Approval Date: � By: <br /> Zoning File: # 04, 3�� � Resolution: # Resolu[ion Date: S- 2Y- o�J <br /> Shoreland Dis[rict: Nv <br /> Avg. Setback: Bluff Setback: L.otCoverage: <br /> Ezisting Proposed <br /> Hardcover: 0-75' <br /> �� 75-250' <br /> � 250-SQO' <br /> 500-1Q00' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REMA.RKS (in house): Owiv 2�2. ,Nws T � S►b N �'o�-���� ►q'cc.�sso/Zy <br /> srrfl-�c-rv Jl-C. Gove�v,e,r,�,t,.-r-`. <br /> 7 <br />