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, CHECK OFF LIST FOR TSSUANCE OF PERi1�LITS <br /> � FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: _ Z►;� (�t}y v�t u: Pi..�a�„; � <br /> PID: <br /> DESCRIPTTON OF WORK: S}�L--b <br /> ----------------------------------- <br /> ZONING REV]Eti� BY: � DATEAPPROVED:~� 26 `i�~- <br /> BUILDTYG REVLE�'V BY: : DAT�APPROVED: Y3�-� .�i� <br /> _ , <br /> . ----------------------------------=- <br /> �'EES TO BE CHARGED: � Misc. Pees Calculated By: <br /> PERNIIT Yes �/ � No ' <br /> PLAN REVIEW Yes � No �/ SEWER COYNEC'TION <br /> STATE SUR�H�G� yes � No ti��,TER C0�INECTION <br /> INVESTIGAT'ION-FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTTON <br /> Number of SAC Units OTHER (specify) <br /> ------------------------------------------- ---- <br /> ZOtiTING CHECK LIST Zoning District: L./:' -jG <br /> Fire Department: Post Office: School District: � <br /> . �� <br /> I.at Area: Sq.ft. Acres tiVidth Depch <br /> l. <br /> Survey Submitted: Yes vc No Date of Survey: �,v ,^_� _ <br /> Proposed Setbacks: <br /> Front (Lake): . ��,� � Right Side: C'iL ' �_ <br /> Rear(Street): Z S� Left Side: _ �'Z' }� <br /> Adjacent Structures: �2' � tiVetland: N I�/� <br /> Building Height: Def. Hgt. U< <<- Peak Hgt. <br /> Lot Coverage: <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: gy; • <br /> Zoning File: # Resolution: # Resolution Date: � <br /> Shoreland Dis�ict: � � <br /> A� � � Avg. Setback: Bluff Setback: Lot Coveraoe: <br /> ��� Ezistin <br /> � Proposed <br /> Hardcover: 0-75' <br /> 75-250' . . � � <br /> 250-500' . . <br /> 500-1000' <br /> . Hazdcover Variance Required: Yes No Date of Council Approval: <br /> Y <br /> RE1I�ZARKS (in house): <br /> 3 � . ' <br /> ' '` 26 <br /> . ��� . . <br />