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, CHECK OFF LIST FOR ISSUANCE OF PERtiIITS <br /> ' FOR OFFICE USE ONL,Y • <br /> ADDRESS OR LEGAL: 1 D �-'r�S`f1�� C'�6EK <br /> PID: 33-I1$- �3 33 000'7 <br /> DESCRIPTION OF WORK: SGtt,�-t:t� Po2c�t� <br /> ZOr�"G REVIE`V BY: N-R�S �-- DATE APPROVED: 2 -ay-o 0 <br /> BL'ILDL�tG REVIr`V BY: DATE APPROVID: z -zs o� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PER��IIT Yes ,� No <br /> pLAN REVIE� Yes ,� No SE`VER CO�'ECI'ION <br /> STATE SURCHARGE Yes �/ No �VATERCOi�t�v�C'IION <br /> INVESTIGATION FEE Yes No f PARK FEE <br /> SAC Yes No �-- SITEI�i TSPECTION <br /> Number of SAC-Units OTHER (specify) <br /> ZO``L`�G CH�CK LIST zoning Districr R- l �. <br /> Fire Department: �-- Post Office: a S3SC� School D��LLict: � � 7'8 <br /> Loc Area: Sq.ft. ���1�� Acres �� J`'J�� Width IRct-C��'�-/z- Deptlz �(�j(o� <br /> Survey Submitted: Yes /� No Date of Survey: ��'"l4' `l� <br /> Proposed Setbacks: � <br /> Front(Lake): ��� } Riaht Side: �rt <br /> Rear (Street): �OO� I.eft Side: 1�v�t <br /> Adjacent Structures: ^�la `Vetland: N�R <br /> Building Heioht: Def. Hgt. `v� Peak H?t. D, k <br /> Lot Covera�e: ~ � �� ' <br /> Gradin�: Staff A-proval Date: /��r� By: Council Appro�-�1 Date: <br /> Septir. Scaff Agproval Date: 2�Z`�—D O By: (� <br /> Zonin�File: # — Resolution: � Resolution Date: <br /> Shoreland District: fv o <br /> Av�. Secback: Bluff Setback: LotCo�9ra�e: <br /> Existma Progosed <br /> Hardcover: 0-75' <br /> 7�-2�0' <br /> 2�0-500' <br /> 5Q0-1000' <br /> Hardcover Variance Required: Yes No� Date o`Counci Approval: _ <br /> REI�iA.RKS ('ln house): �✓ <br /> 7 <br />