Laserfiche WebLink
� C•HEC�i OFF LIST FOR ISSUA1ti7CE OF PERI�IITS <br /> _ FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: �3S �- ti-�tZ..rr r��� <br /> PID• <br /> DESCRIPTION OF�ORK: �!��� � �� <br /> ZOrZ`'G REV�`Y BY: � DATE APPROVED: q -Z�-c�a <br /> BUII�DING REVIE`Y BY: DATE APPROV�D: � -� -�� <br /> FEES TO BE CHARGED: Niisc. Fees Calculated By: <br /> pERMIT Yes (� No : <br /> pLAN REVIEW Yes � No SEWER CONNECTION <br /> STATE SURCHARGE Yes �/ No WATERCONNECITON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZO�G C�CK LIST Zon',ng District: 2 2-�(j <br /> Fire Department: wA��Z�� Post Office: wA�z�� School District: <br /> I.otArea: Sq.ft.�1 2.� 1 Acres �Z,`1t0 Width �fL�(�bu�/Z Depch <br /> Survey Submitted: Yes oC No Date of Survey: �a r'��: <br /> Proposed Setbacks: � <br /> Front (La.ke): �0 – Right Side: � '�5 <br /> Rear (Screet): 2'�� � � Left Side: !3�`l <br /> Adjacent Structures: A-rTMG lt�:� Wetland: N I� � . <br /> Buildin� Hei�ht: Def. Hgt. 0 •(� Peal:Hgt. c9�1G <br /> Lot Coverage: �.I (A <br /> Grading: Scaff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: "' By: <br /> Zonin;File: # ZS Z-S Resolution: � �(3`�(� Resolution Date: /(- Z Z- 9�! <br /> Shoreland District: �b <br /> Av'. Setback: Blufi Se[back: I.otCo��era�e: <br /> EziscinQ Proposed <br /> � <br /> Hardcover: 0-75' <br /> 75-250' <br /> ti0-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REtiLA.RKS (in house): <br /> 7 <br />