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• ' CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRE,SS OR LEGAL: Z�i to S C Pt S C� Po�.�,-r (2 0�.> <br /> PID: <br /> DESCRIP'rION OF WORK: �(L4-�Q Irv(o <br /> ZO�tIl�tG REV�W BY: DATE APPROVED: /D -z Y-5 7 <br /> BUII,DING REV�W BY: — DATE APPROVED: <br /> FEES TO BE CHARGED: �,2F���N(, Misc. Fees Calculated By: <br /> PERNIIT Yes t/ No <br /> PLAN REVIEW Yes No SEWER CONNECTTON <br /> STATE SUR`HA1�Gr. Yes No WATER CONNECTION <br /> INVESTIGAZ'ION-FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONIlVG CHECK LIST Zoning District: <br /> Fire Department: Post Office: School District: <br /> I.ot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: <br /> Frvnt (Lake): . Right Side: <br /> Rear (Street): Left Side: <br /> Adjacent Structures: Wetland: <br /> � Bullding Height: Def. Hgt. Peak Hgt. <br /> � Lot Coverage: <br /> Grading: Staff Approval Date: 10 ' z-�- 4 � By: ��d� Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File: # Resolution: # Resolution Date: � <br /> Shoreland Dis�-ict: <br /> Avg. Setback: Bluff Setback: Lot Covenge: <br /> - Ezisting Proposed <br /> Hardcover: 0-75' <br /> 75-250' . � <br /> 250-500' . <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS (in house): <br /> • 26 . <br />