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CHECiK OFF i,IST FOR ISSUANCE OF PERIVIITS <br /> FOR OFFICE USE ONLY <br /> A.DDRESS OR LEGAL: 3�1 Zy L As� c..���.�:. s� _ <br /> PID: <br /> DESCR�'I'TON OF WORK: Fite�r �aR.cFr ,4.,..�4 ,�c/t6Aua <br /> ZOYI�tG REVIE`V BY: AATE APPROVED: s -zb-07 <br /> BITILDING REVIEtiV BY: DATE A.PPROVED: s.z� o� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEti�I � Yes ,/ No SE`VER C0�INECTTON <br /> STATE SURCHARGE Yes J No tiVATERCONNECTTON <br /> INVESTIGATION FEE Yes No f PARK FEE � <br /> SAC Yes No � SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> -------------------------------------------------------------------------------------------- <br /> ZONI�IG CI-�CK LIST Zaning District: G/L��� . <br /> Fire Department: Pos[O�ce: School District: <br /> Lot Area: Sq.ft. I�, t�t� Acres •ti 2 Width �� Dep[h <br /> Survey Submitted: Yes �c No Date of Survey: �- 1 t�-0 b <br /> Proposed Setbacks: <br /> Front (Lake): �Zs'f Right Side: �{a' '� <br /> Rear {Street): (�9� �' Left Side: Z�•"1� � <br /> Adjacent Structures: �-r-r�c.t-t-c�—y� Wetland: ,J ��1 <br /> Buildin� Height: Def. Hgt, rvo ca.�,�►r� Peal:Hgt. — <br /> Lot Coverage: 1 3�'Jo <br /> Grading: Staff Approval Date: ^!�p By: — Council Approval Date: — <br /> Septic: Staff Approval Date: N�►4 �Y� — <br /> Zonin� File: (# pb-3i9? Resolution: # Resolution Date: 5- ZZ-06 <br /> Shoreland District: y es <br /> Av;. Setba� �•1�- Sluff Setback: (tiJ (A L.o[Covera�e: i ��� <br /> Etisting Proposed <br /> Hardcover: 0-75' 0 b <br /> 75-250' �•� <br /> 2�0-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes �_ No Date of Council Approval: �-ZZ•�� <br /> RE`�LARKS (in house): �rwc2 �Rsc►�c�T <br /> �c2 f�UtNs oc2��T p���y6� - <br />