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; . <br /> �HEC�K OFF i�IST FOR ISSUANCE OF PE�'VfITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: Z� C���-� � �D� W <br /> PID: <br /> JDES CRII'1�ION OF W ORK: (`�r�5�nncav ,— �Z��-o✓��� -- <br /> ZO�G REVLEtiV BY: ----(V I `A_�___._ pAT'E APPROVED: <br /> S�UII�DIl�IG RE'VIEtiV BY: . DATE APPROVED: q-5'-p� <br /> FEES TO BE CHARGED: Misc, Fees Calculated By: <br /> PERMIT Xes ,/ No <br /> PLAN REVIEti�T � Yes ✓ No SEtiVER CO�INECTION <br /> STATE SURCHARGE Yes ✓ No �'VAT�C�N����� <br /> INVESTIGATION FEE Yes No �' PARK FEE <br /> SAC Yes No �/ SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZO�G CI-iE.CK LIST Zoning District: /U v GH�1��j�2 . <br /> cJ <br /> Fire Department: Post Office: School District: � <br /> Lot Area: Sq.ft. Acres Width PeP� <br /> Survey Submi[ted: Yes No Dace of Survey: <br /> Proposed Setbacks: � <br /> Froat (Lake): Riohc Side: , <br /> Rea.e �S�icetj: Left Side: <br /> AdjaCeat S[Cu�CLres: e1la.ud: <br /> Builclin�Heiohr. Det. Hgt, Peal:Hgt. <br /> Lot Coverage: <br /> Grading: Scaff Approv� Date: By: Council Approval Date: ' <br /> Sepcic: Stafi Approval Dace: Y: <br /> Zoain� File: R Resolution: � Resolur,on Dace: <br /> Shoreland District: Lot Covera�e: <br /> Avg. Setback: Btuff Secbac : <br /> Ecisting Proposed <br /> Ha,�'dcover: 0-75' <br /> �5-2sa� <br /> 2�0-500' <br /> 500-1dG�J' <br /> �"12.fLCOti�i �r'c:!2uC� .n.�^yU'.;�C�: :.�� �,r0 �'':: CF C0�!IlCI� !��rLOVz: <br /> F.E�L��S (in house): <br />