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CAECK OFF LIST FOR ISSUANCE OF PERMITS <br /> ' FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: i�'-15 Gb b�W c�o� t�i�,LS �?�c,,4o <br /> PID: bZ- 11—i- 23 `t t t�oo3 <br /> DESCRIP'TION OF WORK: A dd i n on� . <br /> ZO�tIl�tG REVIEW BY: DATE APPROVED: q-z 3•5 7 <br /> B[.TII,DING REVIEW BY: DATE APPROVED: 5 - z 3-S 1 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes � No <br /> PLAN REVIEW Yes ✓ No SEWER CONNECITON <br /> STATE SUR�HARGr Yes f No WATER CONNECTTON <br /> INVESTIGAZ'ION-FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number o�SAC Units OTHER (specify) <br /> ZONING CHECK LIST zoning District: _ R 2- ►� <br /> Fire Department: w,q.�,-�-,y+ Post Office: �,�,�.{,�. School Disuict: ��„¢-r�9 <br /> —T' ' <br /> Lot Area: Sq.ft. $Z.,�65 Acres I•�j 1�Vidth //1J1L��uc�/� Depth <br /> Survey Submitted: Yes_� No Date of Survey: t{- 1�� � <br /> Proposed Setbacks: <br /> Front (Lake): . QO` t Right Side: Z2' } <br /> Rear (Street): Z`�5 � + Left Side: q�' t <br /> Adjacent Structures: `�1• $3 Wedand: nl�� <br /> Building Height: Def. Hgt. D •1�- Peak Hgt. — <br /> Lot Coverage: D .(L <br /> Grading: Scaff Approval Date: /1�/(� By: Council Approval Date: <br /> Septic: Staff Approval Date: /v//� By: <br /> Zoaing File: # ��5 � Resolution: # Resolution Date: 4 • Z z - S 7 � <br /> Shoreland DisL-ict: <br /> Avg. Setback: Bluff Setback: L.ot Coverage: <br /> � Existing Proposed <br /> � Hardcover: 0-75' <br /> rJ' 75-250' . <br /> 250-500' � <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> RE�ZA.RKS (i.n house): <br /> � 26 . <br />