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CHECK OFF LIST FOR ISSUANCE OF PERNIITS <br /> FOR OFFICE USE ONLY � <br /> ADDRESS OR LEGAL: ��3 ZS C�Ls� �-b�w► 2o A�-✓J <br /> PID: <br /> DESCRIPTION OF WORK: �o�cc�t ✓��o�-r-ti�� <br /> ZOr'Pi 1G REVIE`� BY: DATE APPROVED: t� - i2- g q <br /> BUILDL�tG REV�tiV BY: DATE APPROVED: � i - i z..-gS <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> P�RNIIT Yes ✓' No <br /> pLP,N REVIEW Yes � No SEWER CO�INEC'I'ION <br /> STATE SURCHARGE Yes c/ No WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No STTEINSPECTION <br /> Number of SAC-Units OTHER (specify) <br /> ZOr�tG CHE.CK LIST Zoning Dis[rict: (�R-i G <br /> Fire Department: �v.v✓� Post O�ce: �,�,/A y-tA-1�'� School District: �re srorv kil- <br /> Loc Area: Sq.ft. t�-1, '43S Acres , �� Width S 1•l�� fi�4��Depth Z(.O� �- <br /> Survey Submitted: Yes �L No Date of Survey: 9 `1�l �5 <br /> Proposed Setbacks: <br /> Ftrafft(Lake): ►�3 Right Side: �z� � <br /> Rear (Street): 1 ZZ Left Side: 2�� �- <br /> Adjacent Structures: p�7'SY,iLI�t-�'� Wetland: — <br /> Buildin�Height: Def. Hgt. 0 . �� Peak Hg[. C�.f�-. <br /> Lot Covera�e: o��� � <br /> Grading: Staff Approval Date: N I� By: N� Council Approval Date: �//� <br /> Septic: Staff Approval Date: /v�/�- By: /`��� <br /> Zonin�File: # 252'a Resolution: # 4�1� Resolution Date: 1 I-Q��9� <br /> Shoreland District: �.e s <br /> Av�. Setback: /v/�- Bluff Setback: ���- Lot Coverage: /✓/� <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' s�-t�? `'�5' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes�„_ No Date of Council Approval: 1�-°� �`�� <br /> RE�i.ARKS (in house): <br /> 7 <br />