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� CHECIK OFF i.IST FOR ISSUANCE O�' �E��TS <br /> FOR OFFICE USE ONLY <br /> � D(�. <br /> A)DDRESS OR LE�AL: � � 1 J C v�����`� S' �C� P <br /> PID: <br /> T3ESCRII''I'ION OF WORK: OCc-�� <br /> -------------------- <br /> ZO�G REVIE�4V BY: .� DAT`E APPROVED: S • G � o � <br /> BUII�DING REVIE'4V BY: � DATE APPROVED: � •Z� •O � <br /> k`EES TO BE CHA.RGEA: Misc. Fees Calculated By: <br /> P�g�T Yes � No <br /> PLAN REVIEtiV Yes -� No SE�VER CO�INECTION <br /> STATE SURCHAR.GE Yes —� No �VATERCONNECTION <br /> INVESTIGATION FEE Yes No c/� PARK FEE <br /> SAC Yes No � SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZONING CTrLE.CK LIST Zoaing District: <br /> Fire Departmen�: Posc Office: School District: <br /> Lot Area: Sq.ft. Acres �•� 1 Widch Depth <br /> Survey 5ubmicted: Yes No � Date of Survey: i � <br /> � ,_ Jf', �' : <br /> Proposed cks: � /� �'�(���G �,�:f` r ` <br /> ro (Lake): ���� ��t Side: V , <br /> i ' �i 151 v�v p ' <br /> L�ft Side: ,- r� V(/-P� �l� ?�"�6���`:p_-, <br /> Rear(St;eet)� , � <br /> - � . r <br /> �.u���P�r jrntChlrzj; �/(✓� �\jPelan�: ' Y� • <br /> ,4 ��'�It/V,�V�/�1/"�' <br /> Builclir_g Height: DeE. Hgt, /J ( Vl- Peal�Hgc. — <br /> Lot Covera�e:N <br /> Grading: Staff Approval Date: �..J t v°� By: � Councll Approval Date: ' <br /> Septic: Scaff Approval Date: �' �j !J �"� �Y� �'`1� <br /> Zoaing File: � /U`� Resolutioa: R Resolution Da[e: <br /> Shoreland Dist:icc: Iv� <br /> Avg. Setback: B!ufi Setback: L.otCovera�e; <br /> Eusting Proposed <br /> Harecover: G_i�, <br /> 7�-250' <br /> 2�0-500' <br /> 500-1C�C�J' <br /> �3C2 Oi COl17C'� r.p rn`�al: <br /> Ha��dco�er V�i�.ce Requirzd: Ye� ��c p..,._ <br /> R.E�L�R�S (in house): <br />