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r <br /> • CHECK OFF LIST FOR ISSUAi�TCE OF PERNIITS <br /> ' � FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: ( p C W�2 P��-�= <br /> PID: <br /> DESCRIPTION OF WORK: /-�p/J�n�.•� �- I�'l�u�^�T �.��y <br /> • __ ___--------------------____ _ _ <br /> ZO��i G REVIE`V BY: DATE APPROVED: 7�u�- o 0 <br /> BUILDING REVIEW BY: DATE APPROVED: 'g.-zo - va <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes _� No , <br /> PLAN REVIEW Yes _�G No SEWER CONNECTION <br /> STATE SURCHARGE Yes t� No WATER CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZONI:YG CH�CK LIST zoning Districr. �,2-I� <br /> Fire Department: /V(.d v.� Post Office: lL�v.� School District: (,�+�f�k'f' <br /> LotArea: Sq.ft. 3�?`'���1 Acres • b`i Width ��Uu:�v��-- Depth -- <br /> Survey Submitted: Yes�_ No Date of Survey: Z `Y� <br /> Proposed Setbacks`. <br /> �raQr(Lake): 2 t1' Right Side: L S� <br /> B.ee�(Screet): �o � Left Side: �,,3 f <br /> Adjacent Structures: /}•�^SZ�t�t,c� Wetland: /� ��' . <br /> Building Height: Def. Hgt. �y,,�– Peal:Hgt. G� � <br /> I.ot Covera�e: -- <br /> Grading: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # — Resolution: # Resolution Date: <br /> Shoreland District: U�S <br /> Av�. Setback: d. � Bluff Setback: L.ot Covera�e: <br /> Eus[ing Proposed <br /> Hardcover: 0-75' <br /> 75-250' 2�.?$ Z •3 o z <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No �-_ Date of Council Approval: <br /> REMARKS (in house): <br /> 7 <br />