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r! � I � <br /> CHEC� OFF i�IST FOR iSSUANCE O�' PERMITS <br /> FOR OFFTCE USE ONLY <br /> ADDRESS OR LEGAL: 32S� GASc�o G�izc L.c= <br /> PID: <br /> DESCRIPTION OF WQRK: NCCc�.S R-�=S • <br /> --- ---------------------------------- <br /> ZO.�Ni G REV]T`V BY: � DAT`E APPPOVED: S- Z-o b <br /> BUII�DING REVIE`V BY: DAT'E APPROVED: s-z - 06 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIE`V � Yes -� No SE�zTER CO�]NECTION <br /> STATE SURCHARGE Yes r/ No WATERCONNECTTON <br /> INVESTIGATION FE� Yes No ✓ PARK FEE <br /> SAC Yes No ✓ SITEINSPECTION <br /> Number of SAC Units PA,cI peR�,T �i�99 Y•z6•6g OTHER (specify) <br /> ZONI�IG CHE.CK LIST Zonin; District: C..2-►�- , <br /> Fire Department: Post O�ce: _ School District: <br /> Lot Area; Sq.ft. 1 e,�i 5 Acres .3� Widch L o� Depth <br /> Survey Submitted: Yes x No Date of Survey: I•(b -Ob <br /> Proposed Setbacks: <br /> �r.v�at (Lake): � 2u. Z Rigbt Side: S �u <br /> F2ear(Street): 56 Left Side: n( 13 <br /> Adjacent Structures: �v��4. Wetland: �l IA <br /> Builclin� Height: Def. Hgt, z 2•7 S Peal:Hgt. Z"? <br /> Lot Covera;e: )y• Z <br /> Grading: Staff Approval Date: S • 2- oe T.1L BY: — Council Approval Date: �" <br /> Sepcic: Staff Approval Date: ��t BY� �� <br /> Zoning File: � ob-3��t� Resolution: � Resolution Date: 3- i 3- oe <br /> Shoreland District: y-PS <br /> Avg. Setback b.l�- B1uff Setback: N��4 Lo[Covera�e: �4•2 <br /> E�.istinQ Proposed <br /> 0 <br /> Hardcover: 0-75' c•t� �'b <br /> 75-250' I�.y 2 2`►.9� <br /> 2�0-500' Z�e• �t ffi �°'�' <br /> S00-lOdO' <br /> Hardcove: Variance Required: Yes o� No Da�e of Council Approvzl: 3''3 -£�a <br /> RE`�L4RKS (in house): <br />