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CHECK OFF LIST FOR ISSUAi�10E OF PERI�IITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: Z�l ��1 C 1��tvN��i 5.T <br /> PID: <br /> DESCRIPTION OF WORK: �,C„« <br /> ZOrTvi G REVIEW BY: DATE APPROVED: 7- �9 - �1 <br /> BUII�DING REVIE`V BY: DATE APPROVED: -�- i 5 - o'( <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes ✓ No <br /> PLAl�T REVIEW Yes v� No SEWER CONNECTION <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 /> ZOrTi 1G CH�CK LIST Zoning District: C.2� I Q <br /> Fire Department: ��,v�,� Post Office: ���9 School District: l�t CST-c��►kh <br /> Lo[Area: Sq.ft. No C I�.�P Acres Width Depth <br /> —�- <br /> Survey Submitted: Yes c No Date of Survey: �-(-1 $-(�I <br /> Proposed Setbacks: <br /> �rvet (Lake): 26�I Right Side: N ,��(�l <br /> F�ea�(Street): �0 Left Side: /Z.c� <br /> Adjacent Structures: /b'rT7��.ttt�0 Wetland: �f�. <br /> Building Height: Def. Hgt. Peak Hgt. — <br /> Lot CoveraJe: p (L <br /> Grading: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: !# — Resolution: # Resolution Date: <br /> Shoreland District: ��5 <br /> Avg. Setback: v• (� Bluff Setback: /'�(✓►' L.ot Coverage: p�(< <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> Zso-soo� D. k <br /> 500-1000' <br /> Hardcover Variance Required: Yes No�_ Date of Council Approval: <br /> RENIARKS (in house): <br /> 7 <br />