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, CHECK OFF LIST FOR ISSUA2r7CE OF PER1tiIITS <br /> . ' FOR OFFICE USE ONLY <br /> A.DDRESS ORLEGAL: �� SS r(3�4� SiO� /L�� <br /> PID: b� <br /> DESCRIPTION OF WORK: NLs� /L�3 0� L�i5�7 -�� a�' `^��J�J��aWs <br /> ZOrT�i'G REV�`V BY: DATE APPROVED: �j - �3 - D� <br /> BUII�DI�i tG REVIE`V BY: DATE APPROVED: �r - / 3 -ov <br /> F'EES TO BE CHARGED: Misc. Fees Calculated By: <br /> pERMIT Yes ✓' No . <br /> pLAN REVIEW Yes ✓- No SEWER CONNECI'ION <br /> STATE SURCHARGE Yes �� No WATERCONNECITON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No STTEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZONI:�tG CI�CK LIST zoning Districr. R(Z.-�(3 <br /> Fire Department: u: Post Office: School Disuict: l,��e s��'`� �`'� <br /> Lot Area: Sq.ft. Acres � �t Widch �N?.l��J�•4✓L Depch <br /> Survey Submitted: Yes_ L Iv'o Date of Survey: <br /> Proposed Setbacks: , <br /> Froat (Lake): �S'.7 ` Ri;ht Side: 3 Z•5 <br /> Rear (Street): 3 35 � t Left Side: ((.9 � <br /> Adjacent Structures: /�l//-� Wetland: Iv/A- . <br /> Buildin; Height: Def. Hgt. �� �� Peal:Hgt. <br /> Lot Covera�e: — <br /> Grading: Staff Approval Date: — By: Council Approval Date: <br /> Sep[ic: Staff Approval Da�e: S• Zo 'S�t C.P gy <br /> Zonin� File: # — Resolution: # — Resolutioa Dace: <br /> Shoreland District: 1� � <br /> Av�. Setback: Bluff Setback: I.oc Covera�e: <br /> Existin� Proposed <br /> a <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REI�LARKS (in house): �- J r/O�i L�N ,,.�s �G�9 � iUav � <br /> c�N �4� O J P_� /kw� D/n� u� ✓.vi0 <br /> W Z s�ns !`h9� `� <br /> 7 <br />