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� <br /> . ' . CHECK OFF LIST FOR ISSUA.I�tCE OF PER1l�IITS <br /> '_ FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: �l z 5 �� �=�N O I'��-l'� <br /> PID: <br /> DESCRIPTION OF WORK: � r4�dLA��. ,/�(I� t 1.�7 <br /> ZOtiT\'G REVIE`V BY: � DATE APPROVED: �' Z�(- � <br /> BUILD�tG REV�`V BY: DATE APPROVED: � -2 �( —�J <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> pERMIT Yes � No :. <br /> pLAN REVIEW Yes � No SEWER CONNEC"ITON <br /> STATE SURCHARGE Yes � No WATERCONNECI'ION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZO�L�1G CH�CK LIST Zoning District: �� -1 � <br /> Fire Depar[menr. w,�}�.,--��y� Post Office: c�prTtl�t School District: W�4�f�-i�l4 <br /> L,ot Area: Sq.ft. N� Cf�f�4Nr.,,Q Acres Width Depth <br /> Survey Submitted: Yes � No Date of Survey: �� '�� <br /> Proposed Setbacks: <br /> Fron[ (Lake): l l �2.- RiDhc Side: �30 <br /> Rear (Street): l'�� Left Side: `{O <br /> Adjacent Structures: ��(_(.�.�,c,� Wedand: — . <br /> Buildin� Height: Def. Hgt. p, 1� Peal:Hgt. <br /> Lot Covera�e: — <br /> Grading: Staff Approval Date: — By: Council Approval Date: <br /> Sep�ic: Staff Approval Date: — By: <br /> Zonin; File: # — Resolution: # Resolution Date: <br /> Shoreland District: �v U <br /> Av�. Setback: Bluff Setback: I.ot Covera�e: <br /> Existin� Proposed <br /> a <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-SQO' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REI�L�RKS (in house): <br /> 7 <br />