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• CHEC�K OFF i.IST FOR ISSUANCE OF PERiI�fITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: )�`-I'3� �✓►�l wc,�cs2.T �X'- - <br /> PID: <br /> DESCR�TION OF WORK: �Q,�,I ^ e-c-k.. o� �x�Shn�r s icle-c�alk � r���o <br /> ------------------------- <br /> ZO�G REVIE`V BY: -----�___�y--__-- pAT'E APPROVED: �' <br /> SUII.�DING REVIEtiV BY: �(D. ,�— . DATE APPROVED• ) � <br /> -------- --=--------- ------ ---------------------------=-------------��--------------- <br /> FEES TO BE CTLARGED: / Misc. Fees Calculated By: <br /> PERMIT Yes r/ No <br /> PLAN REVIE`V � Yes � No SE��TE.R C�NNECTION <br /> STATE SURCHARGE Yes � No WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ----------------------------------------------------- <br /> ZONI�IG CHE.CK. LIST Zoning Districr. ��� ~ (� <br /> Fire Department: Post Office: School District: <br /> � <br /> L,ot Area: Sq.ft. � ��tP L � Acres Widch 3�:� Depth 2 r03 <br /> Survey Submitted: Yes ✓ No Date of Survey: � � <br /> Proposed Setbacks: � NWt lO � � <br /> Froa[(Lake}; �2� �ttSide: <br /> S�N� � <br /> Rear (Street): �eft Side: �_ _ <br /> P.djaceat St:vc!ures: Wetland: �1�' <br /> Builclin; Hei�t: Def. Hgt. N/� _ Peal:Hgt. <br /> Lot Covera�e: �� <br /> Grading: Staff Approval Date: By: Council Approval Date: ' <br /> ��A' By: W�� <br /> Sepcic: Scaff Approval Date: Lv�_ <br /> Zoaing File: � Resolution: � Resolution Date: <br /> Shoreland Districc: " <br /> Av�. Setback: Bluff SetSack: L.ot Coverage: <br /> Eustin� Proposed Q _.�� <br /> �'���l � �,� Hardcover; d-7�' � �- I� 2��3 �`�� <br /> % �� \ 75-250' �D��i� 7 S iC��— <br /> � � �3��'°` z�o-Soo� c�� � �a� <br /> ���o. a v soa-��� <br /> o� Q�' <br /> H��dcover Va-iance Required: Yes No Da�e of Council Appro�at: <br /> FE�L4RKS (inhouse): h��s� 1 oZ�+d' � <br /> , <br /> l S csL. <br /> dF ,e,i r�G��, vt�.-t �� �e� <br />