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� CHECK OFF LIST FOR ISSUAl�'CE OF PERtiIITS <br /> , FOR OFFICE USE ONLY - <br /> ADDR�SS OR LEGAL: 5 y u C3A R 2� �1 v t= _ <br /> PID: <br /> DESCRIP'TION OF WORK: a2w�.�i� ��� n s�s <br /> ------ — -- ---------- . <br /> ZO.�tI�i 1G REV�`V BY: DATE APPROVED• ,es�l�-Z -g g <br /> BUILDLIIG REV�`V BY: ,,,,� DATE APPROVED; i�- z-�9 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓� No <br /> pLAN REVIEW Yes �/' No SEWER CONNECITON <br /> STATE SURCHARGE Yes � No `VATERCOi�1NECITON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yvs No SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> Z0�1G CH�CK LIST Zoning District: R R- 1� <br /> Fire Department: (�o�u h V4tc,� Post O�ce: ���.�,� School District: c��� <br /> I.otArea: Sq.ft. 3�,�Vo Acres ,'�� Width 30+� Dep[h � 2`l .S`7 <br /> Survey Submitted: Yes� No Date of Survey: 3 -2�'�v <br /> Proposed Setbacks: <br /> Front(Lake): 2 S, Right Side: �� ' � <br /> Rear (Street): Ss� Left Side: `'�� <br /> Adjacent Structures: N G� Wetland: ��� <br /> Buildin�Height: Def. Hgt. p.K Pea�:Hgt. �° C��''�� <br /> Lot Coverage: B•` ' <br /> Grading: Staff Approval Date: /��!/� By: — Council Approval Date: —' <br /> Septic: Scaff Approval Date: �'✓�ri9' By: r-- <br /> Zoning File: # � '���Resolution: # Resolution Date: /n•2 5 '9 9 <br /> Shoreland District: .rl-05 <br /> Av�. Setback: /11i� Bluff Setback: i✓li�- I.oc Coverage: � b <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 /> 7 <br />