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� <br /> CHEC3K OFF i,IST FOR ISSUANCE O�' �ERNIITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: �2 �{ ��"� 1.7�,✓� ��x�'�-J_,L� �c� <br /> PID: <br /> DESCRLP'TIO�I OF WORK: �c�,�. o �. � � s��� 5� <br /> --- ---------___---�__.----------------- <br /> ZO,�i G REVIE`V BY: �I I�� � I �, DATE APPROVED: 7-�-c�� <br /> BUILDING REVIE'�V BY: DA'I'E APPROVED: � - s-o� <br /> FEES TO BE CHA.RGED: Misc. Fees Calculated By: <br /> PERMIT Yes � No <br /> PLAN REVIE`V Yes �' No SE�VER CONNECTION <br /> STATE SURCHARGE Yes —� I�o tiVATERCONNBCTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTTON <br /> Number of SAC�Units OTHER (specify) <br /> ------------------------------------------------------------__ <br /> ZONIl�IG CHE.CK LIST Zoni.ng District: �'�+ � , . <br /> Fire Department: Pos[Office: Schaol District: ` <br /> L,oc Area: Sq.ft. J��f�I j� ��Acres � ' ��I Wid[h Dep[h <br /> Survey Submitted: Yes No �`'. Date oE Survey: �-�`'���3 <br /> Proposed Setbacks: . <br /> Froat (Lake): Riaht Side: <br /> Rear (Street): Left Side: � G�.�.�o O <br /> A,�•��P�r �rn�ctures, Wetland: <br /> ,.;.. <br /> Buil�lin� Hei�t: Def. Hgt, Pealti Hgt. <br /> Lot Covera�e: <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Sepuc: Scaff Arr <br /> roval Date: �Y� �� <br /> Zoaing File: � ^ Resolution: � Resolution Date: <br /> Shoreland Distric[: <br /> Av�. Setbac : (�_ � Bluff Se[back: n//,2 I..otCoverage: �• <br /> EListin� Proposed <br /> 0 <br /> Hardcover: 0-75' ,,��, 7 /�(� <br /> 7�-250' � G ' �� +° C l-��'`�� <br /> 2�0-500' <br /> 500-1000' <br /> H��dcover Variance Required: Yes No X Da�e of Council Approval: <br /> FE�lL4R�iS (in house): S-Qt �.Q„r„�..T # PD �6YY td GL �o U-n s� �- f!.C_ <br /> --� <br />