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� �HECK OFF i,IST FOR ISSU.ANCE O�' �'EK.�K.�IITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEuAL: ��l'1 S C p���-�-1 S , c�Q ��• <br /> Pli7: <br /> DESCRLP'IZON OF�VORK: z lt,�G� A� ��v <br /> ------------------------------------- <br /> ZOYI�iG REV�tiV BY: `-------�/� AATE APPROVED: `� � 1 <br /> SU�ZDING REVIE�V BY. DA.TE APPROVED: S-y- 0 7 � <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> p��T Yes � No <br /> PLAN REVIE`�l � Yes �/ No SE`VER CO�INEC`1TOI�T <br /> STATE SURCHARGE Yes �/ No WATERCONNECTI4N <br /> INVESTIGATION FEE Yes No �/ PARK FEE <br /> SAC Yes No �/ SITEINSPECTION <br /> Number of SAC�Units OTHER (sgecify) <br /> ---------------------------------------------------- <br /> ZQNT.i�IG CHE.CK LIST zoning District: �IQ'1� . <br /> Fire Department: Post�ffice: School District: � <br /> . i <br /> I,ot Area: Sq.ft. �IZ I ZZ�i Acres Z' �� Width 7i�(, � Depth �,� ��7 <br /> Survey Submitted; Yes _ � No Date of Survey: `'� ) � <br /> Proposed acks: �`�� � � <br /> ro (Lake): ���V Ri�t Side: � (, <br /> � . <br /> e (Strez[}: ?/�� laeft Side: 'r ��'� � <br /> i�, .� <br /> Adjacen[ S�ructures: c. ��-�-- �Vetland: t, ° <br /> Buil�lin� Hei�ht: Def. Hgt, o •I�- Pealt Hgt. <br /> Lot Coveraoe: N1(�` <br /> //4- g — Council Approval Date: �f � � . <br /> Gradino: Scaff Approval Date: /J Y� <br /> i � <br /> Septic: Scaff Approval Date: � � 5 'a� BY: � <br /> Zoain� File: 7 ��_ Resolution: n Resolution Date: <br /> Shoreland District: I�u N j � <br /> Avg. Se k: �/ � � Bluff Setback: �) i`Ck _ I-ot Coverz;e: <br /> E�istin� Propased <br /> 0 <br /> ��rdcover: 0-75' <br /> ' 7�-250' <br /> \� 2�0-560' <br /> __��. f� <br /> �c�-��� <br /> ridi�CO'ti2i �+''2.'lcuCe .T�.P.�^.�l!!i'L: :�PS �;p �_ �i3:_ Q�C'J'�!CC11 :��r_OV�: N I �� <br /> F.E�L4RI�S (in house): <br />