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�HEC�K OFF i�IST FOR ISSUANCE �F PE�'VfITS <br /> ' FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAI.,: Z�i�`-( C`�SC� �o�� T �� <br /> PID: � <br /> DESCRIPTION OF WORK: Lrv1(�T�T N�3!-� <br /> ZO�tNG REVIE`V BY: O�l I/� DATE APPFOVED: <br /> SUILDING REVIEtiV BY: DATE APPROVED: (� - Z7-o� <br /> FEES TO BE C�-IARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ,,� No <br /> PLAN REVIE`V � Yes �/ No SE�VER CONNECTION <br /> STATE SURCHARGE Yes ✓ No WATERCONNECTION ' <br /> INVESTIGATION FEE Yes No �,� PARK FEE <br /> SAC Yes No _�� STTEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZONi�IG CI-iE.CK. LIST Zaning District: �Jo_C,�1.�s� . <br /> Fire Departmen[: Post Office: School Distric[: � <br /> L.ot Area: Sq.ft. Acres Widch Depch <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: <br /> Froat (Lake): Ri�t Si : <br /> Rear(Stree[): Left Side: <br /> Adjaceat Structures: � etland: <br /> Buil�lin� Hei�ht: Def, Hgt, eal:Hgt. <br /> Lot Covera?e: <br /> Gradino: Staff Approval Date: By: Council Approval Date: ' <br /> Sepcic: Staff Approval Date: y� <br /> Zoaing File: � Resolution: # Resolution Date: <br /> Shoreland District: <br /> Av�. Setback: Bluff Setback: L.ot Coverage: <br /> E�isting Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 2�0-500' <br /> 500-1000' <br /> �-Ia.rdco�'er Va:iance Required: Yes No Da�z ef Council Approval: <br /> RE�L4RKS (in house): <br />