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, � CHECK OFF i.IST FOR ISSUANCE O�' �'ERIV].ITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEG-AL: I 2Z S D,G�u�so rl srrr.c�r <br /> PID: <br /> DESCRIPI'ION OF WORK: N��✓ i�5 <br /> --- -------• —_____------------------------ <br /> ZOr`Pi IG REVLEtiV BY: DATE APPF'.OVED: ��-Z�-U� <br /> BUlZDI'�i IG REVIE�V BY: DAT'E APPROVED: y- z�'B-o� <br /> F`EES TO BE CH.ARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes �/ No <br /> PLAN REVIE`V � Yes �/ No SEtiVER CO�INEC�ION <br /> STATE SURCHARGE Yes _� No WATERCONNECTION <br /> INVESTIGATION FEE Yes No ✓ PARK FEE <br /> SAC Yes No ,/ SITEINSPECTION <br /> Number of SAC�Uruts Q�,o �Z-Z�,�eZ �5,,,,.,,,r �69 0� OTHER (specify) <br /> ------------------------------------------------------------------------------------ <br /> ZONIv'G CH�CK. LIST Zoning Discricc: R�2• 1�3 <br /> Fire Department: Post Office: School District: <br /> L.ot Area: Sq.ft. Z�,c��,(� Acres � (� Z Widch � 3 S Depch <br /> 5urvey Submitted: Yes o< No Date of Survey: Z' 3- 05 <br /> Proposed Setbacks: <br /> Front (Lake): SO � Righc Side: 33•`'� <br /> Rear (Street): �1 y� Left Side: �'J <br /> Adjacent Structures: N �A Wetland: /�! ( � <br /> Buildin� Height: Def. Hgt. �u� Peal:Hgt. 31�75 <br /> Lot Covera;e: W•� <br /> Grading: Scaff Approval Date: �7- I 1`�� By: C�-. Council Approval Date: — <br /> Sepcic: Scaff Approval Date: ,52.�-•�-e.�- BY� — <br /> Zon'sng File: " o s-3�9 Z Resolution: # 53�� Resolution Da[e: `/•Z s 'Q� O s <br /> Shoreland Distric[: <br /> Avg, Setback: ��,� Bluff Setback: iJ/A� L.otCove�a�e: I D. 5 <br /> Eusting Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 2�0-504' �� <br /> 500-1OQ0' � Z0-�- <br /> Hardcover V�riance Required: Yes No �_ Date of Council Approva!: <br /> REti�L�4RKS (i.n hotue): <br />