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CHEC�K OFF i,IST FOR ISSUANCE OF PE�'VIITS <br /> FOR OFFICE USE ONLY <br /> ADDRESSORLEGAL: ��y5 (—'►q,�C�zrv,:ss PoirvT' ►�"b <br /> PD�: <br /> DESCRIPTION OF WORK: r�c_Zl� <br /> ZO.�i G REVIE`V BY: AATE APPP.OVED: -t- � 2-c�:� <br /> SLIIZDING REVl-E�V BY: DATE APPROVED: -, -i Z.- c�� <br /> FEES TO BE CHARGED: Misc. Fees Catculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIE`V � Yes No SE`VER CONNECTION <br /> STATE SURCHARGE Yes � No `VA'I'ERCONNECTTON <br /> INVESTIGATION FEE Yes No �/ PARK FEE <br /> SAC Yes No � SITEINSPECTTON <br /> Number of SAC�Units OTHER (specify) <br /> ZONi�iG CI-3�CK LIST Zon.ing Districr. LR-�L , <br /> Fire Department: Post Office: School District: � <br /> L,oc Area: Sq.ft. . 5 2 Acres 22,5�� Width Depch <br /> Survey Submitted: Yes _ x No Date of Survey: 2-�—►'�� <br /> Proposed Setbacks: , � <br /> pY6at (Lake): 1 3 S � � Ri�t S ide: q 7 � <br /> Rear (�: l'j.� Left Side: 3`i '-± <br /> Adjacen[ Structures: �.-r>pc.6�-e� Wetland: i✓�� <br /> Buil�lin� Hei�ht: Def. Hgt. /U /✓� Peal:Hgt. — <br /> Lot Covera�e: � �L• � <br /> Grading: Staff Approval Date: ^/ (a4 By: Council Approval Da[e: ' <br /> Septic: Staff Approval Date: ,l/ �tq� By� <br /> Zoaing File: n o S-'�iS� Resolution: n 538�{ Resolution Date: °�- Z-6• 65 <br /> Shoreland District: �, r s _ <br /> Av�. Setbac� yti � ih Bluff Secback: �/!/i- T--otCoverage: � Z. S. <br /> Ecisting Proposed <br /> Hardcover: 0-75' (� � <br /> 75-25Q' �_ 2� 3 <br /> 2�0-500' <br /> 500-1000' <br /> e ' • Ha:dcover Va;ia�ce Required: Yes �C_ No Da�e oE Council Approval: cf- Z�-0� <br /> R.E`L�.RKS (in house): <br />