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� CHECh. OFF LIST FOR ISSUA.��TCE OF PER�tiZITS <br /> FOR OFFICE USE ONLY . ' . <br /> ADDRESS OR LEGAL: ��2 5 c=� �..e�i� s i <br /> PIli: <br /> '�DESCRII'TION OF j'YORK: �U c=�.S t2.�—'S <br /> ZOr'Lti G REY�ti�%BY: D�TE APPROV�D: 6 •�a-01 <br /> BIJ7ZT) .T�'G REYLEtiY BY: � D�TE APPROYID: (,- �8-�"rn c <br /> FEES TO BE CH.4RGED: biisc. Fees C�!culated By: <br /> pEgMIT Yes _�G' No �� <br /> PLAN R.EVIEW Yes �/' No SE�ER CONNECTION <br /> STATE SURCHARGE Yes � No ��ATERCONNECTION <br /> I�i,'VESTIGATION FEE Yes No -� PA�K�E <br /> SAC Yes � No SITEINSPECTION <br /> Number of SAC�Units 1. OTHER (specify) <br /> ZO\1..�tG CH�CK LIST Zonin�Dis�icc: L� - � � _ . <br /> Fire Department: (��L..Ak�: Post.Oiuce: School District: �fLL�1�� � <br /> Lot Area: Sq.fr. Acres 'Z � � Widch ��.�( 2 Depch Z.5 Z .�6 7 <br /> Surve; Sub�itted: Yes�c _ No Date o:Survey: .5• 3► • 01 <br /> Propased Setbacks: <br /> Fron[ (La.ke): Z 2 2 RiQht Side: ' `j'1 <br /> Rear (Street): 5`�•f3`7 Left Side: I '� Z <br /> Adjacent S�ructures: /J �/� �Vetla.nd: /v �� • <br /> Buildin� Hei�h[: Def. H�t. Z(�.5 Pea.�:H�t. �-3 <br /> Lot Covera�e: O •k-- <br /> p� g Council Approval Date: �`J8 � b} <br /> Gradin�: Stafi Approval Date: 6- (� ' y: <br /> Septic: Staff Approval Da�e: nl � l� By: — <br /> Zonin� File: # — Resolution: � — Resoie:ion Date: -' � <br /> ShorelandDistrict: �r S ��Co�•em?e: a•K- <br /> Av�. Setback: p, IL- Blufi Setback: �l I/� � <br /> E���? Proposed <br /> Hardcover: 0-7�' n d <br /> 7�-250' D ��"— <br /> ti0-SC4' U �— <br /> 500-1GQ0' <br /> Hardcover Variance Required: Yes No�_ Da[e of Cou.ncil Aoproval: <br /> gEI�IA..Rb'.S (in house): <br /> 7 <br />