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� CHECK OFF LIST FOR ISSUAI�TCE OF PER1tiSITS <br /> _ FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 2-� Z S C K4-(ZR�-C�� lA r�-p <br /> PID: <br /> DESCR�'ITON OF WORK: (��L � �2.�5 <br /> , <br /> ZOVZ\'G REVIEti� BY: DATE APPROVED: �p - r o . c� <br /> BUILDIPiG REVIEtiV BY: DATE APPROVED: �o - �o- o 0 <br /> FEES TO BE CHARGED: Niisc. Fees Calculated By: <br /> pERNIIT Yes _� No :. <br /> pLAN REVIEW Yes ci- No SEWER CONNECTION <br /> STATE SURCHARGE Yes _� No WATERCONNECITON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZOtiZ�G CHH�CK LIST zoni.n�Dis�icc: (Z C2-1(3 � <br /> Fire Department: (,o�vG (At�-G Post Office: ,.� �c t, School Districr. c�� iv� <br /> Lot Area: Sq.fc. Acres Z + Width i(1,(�r���IC�f�,-2 Depch <br /> Survey Submitted: Yes oL No Date of Survey: Z� ��� <br /> Proposed Setbacks`. <br /> Front (La.ke): $3.�5 Right Side: S� <br /> Rear (Street): �7�� Left Side: S�U <br /> Adjacen[Structures: N//a- �Vetland: . <br /> Buildin; Hei�ht: Def. Hgt. 2o Peai:Hgt. 27 <br /> Lot Covera�e: —' <br /> Gradir.�: Staffr Approval Date: J(� -l(� � Uc� By: �`•�' Council Approval Date: <br /> Septic: Staff Approval Date: [v •!v - p v By: C�P <br /> Zonin;File: # — Resolution: � -- Resolution Date: <br /> Shoreland Dis[rict: N q <br /> Av�. Setback: Bluff Setback: Lot Covera�e: <br /> Ezistin� Proposed <br /> � <br /> Hardcover: 0-75' <br /> 75-250' <br /> ti0-500' <br /> 500-1000' <br /> ) <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> gE�IARhS (in house): <br /> � <br /> 7 ; <br />