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' CHECK OFF LIST FOR ISSUANCE OF PERIVIITS <br /> FOR OFFICE USE ONLY <br /> . ADDRESS OR LEGAL: `I l�l� N o2T�t (3Rowr► ILoA-r� <br /> PID: <br /> � DESCRIPTIONOFWORK: _ (��uc /�-D4i,o� <br /> ZO'vING REVIEW BY: DATE APPROVED: �- 1-5 7 <br /> BUII..DING REV�W BY: DATE APPROVED: �- S-�!� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes i/' No <br /> PLAN REVIEW Yes c� No SEWF.R CONNECTTON <br /> STATE SUR`HARG�E Yes r/ No WATER CONNECITON <br /> INVESTIGAT'ION-�EE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONIlVG CHECK LIST Zoning District: R�C-I�--------------------------------------- -------- <br /> Fire Departmenr. n� r.�' Post OfFce: la.� CAw� School District: p/l.�nr0 <br /> Lot Area: Sq.fr. Il�v C1�.�9,,v��Acres — Width — Depth -- <br /> —T <br /> Survey Submitted: Yes_� No Date of Survey: <br /> Proposed Setbacks: <br /> Front (Lake): . �i U' Right Side: �U� � <br /> Rear (Street): Z Zp '. Left Side: 170� S <br /> Adjacent Structures: (}i-T�9c�bk.c� Wetland: N (A <br /> Building Height: Def. Hgt. (u ��4 Peak Hgt. <br /> Lot Coverage: <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoaino File: # Resolution: # Resolution Date: � <br /> �(•� Shoreland DisL-ict: . <br /> Avg. Setback: Bluff Setback: I.ot Coverage: <br /> - Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' . � <br /> 250-Sa0' . <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REiI�ARKS (in house): <br /> • 26 <br />