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, l . . <br /> , , <br /> CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: Z 9�-t � C, �5 c� Po„v ,— ��/�-r� <br /> PID: � <br /> DESCRIPTION OF WORK: S�-va-�o ,�,�-c,K.�,,� �e L�x ,y�� `� <br /> --- - — --- - -------------- ---------------------------------------- <br /> ZO.vI�ti G REVIEW BY: DATE APPROVED: S -��/-6 Z <br /> BUII.DING REVIEW BY: DATE APPROVED; ,s--�Y-�� <br /> FEES TO BE CHA�RGED: Misc. Fees Calculated By: <br /> PER1vIIT Yes �/' No <br /> PLA��1 REVIEW Yes /� No SEWER CONNECTION <br /> STATE SURCHARGE Yes l� No WATERCONNEC'TION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZO�TING CH�CK LIST Zoning District: <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes�_ No Date of Survey: /- /d• n Z- <br /> Proposed Setbacks: <br /> �eet (Lake): 15Z' �- Right Side: 3� ` �- <br /> � <br /> R�ar (Street): Y�� �- Left Side: �S' �- <br /> Adjacent Structures: ,AT-rX+.c«-�;'b ,� Wetland: — <br /> Building Height: Def. Hgt. D,1� Peak Hgt. <br /> Lo[Coverage: I�.� <br /> Grading: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: � By: <br /> Zoning File: # -- Resolution: # Resolution Date: <br /> Shoreland District: �/�7 <br /> Avg. Setback: �,(� Bluff Setback: � L.ot Coverage: — <br /> Existino Proposed <br /> Hardcover: 0-75' <br /> 75-250' 2 q ZY�� <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No�_ Date of Council Approval: <br /> REMARKS (in house): <br /> 7 <br />