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CHECK OFF i.IST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS ORLEGAL: ( �7 3 r=A�C:�N�sS �o,ivr <br /> P�: <br /> DESCRIPT70N OF WORK: GaGf v'A-�� �� w��=�/��b r o�v7°^f v ✓N�'�°� <br /> ZO.�I�ti G REVIE`V BY: Y---^ /���—r-- DATE APPROVED: <br /> BUILDING REVIE`V BY• � DATE APPROVED: 3•Z-��o 6 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes � No <br /> PLAN REVIEW Yes • No � SEtiVER CONNECITON <br /> STATE SURCHARGE Yes _� No WATERCONNECTTON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ----------------------------------_—_----------------------------------------------------------------------------- <br /> ZONI�tG CHE.CK LIST Zoning District: yU'v Gl� <br /> Fire DepartmenC Post Office: School District: <br /> L.ot Area: Sq.ft. Acres Width Depch <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: <br /> Front (Lake): Right Side: <br /> Rear (Street): Left Side: <br /> Adjacen[ Structures: Wetland: <br /> Buildin� Height: Def. Hgt. Peal:Hgt. <br /> Lot Covera�e: <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoai.ng File: # Resolution: # Resolucion Date: <br /> Shoreland District: <br /> Avg. Setback: Bluff Setback: Lot Covera;e: <br /> EzistinQ Proposed <br /> 0 <br /> Hardcover: 0-75' <br /> 75-250' <br /> 2�0-500' <br /> 500-1d00' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REI�LARKS (in house): <br /> � <br />