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CHECK OFF 3�IST FOR ISSUANCE O�' PERIVIITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: �.�"'�� �+�'.�T' t�`�� ��� <br /> PID: <br /> DESCR�T'ION OF W4RK: �: ��,-> � �•,'����''`�=. <br /> ���������������������������������������������'��������� <br /> ------ --- ------.,.— I���__—___ DATE APPROVED: LO 7' � <br /> ZO�G REVIE'�V BY: � �--..:, <br /> BUILDING REVIEtiV BY: DATE APPROVED: b � 8- O�o <br /> FEES TO BE CHA].2GED: � Misc. Fees Calculated By: <br /> PERMIT Yes No <br /> PLAN REVIE`V � Yes ✓ No SEWER CO�INECITON �'� <br /> STATE SURCHARGE Yes ✓ No WATERCONNECT'ION � <br /> INVESTIGATION FEE Yes No �/ PARK FEE `� <br /> SAC Yes No ` SITEII�TSPECTION -- <br /> Number of SAC�Units OTHER (specify) <br /> -------------------------------------------------l------------------- <br /> ZONi.�IG CHE.CK LIST Zoning Districc: �✓� ' � <br /> Fire Department: Post O�ce: School District: <br /> , � � <br /> L.ot Area; Sq.ft. J � <��i' �''' Acres �� (� s Width � DePth ���S� — <br /> 5urvey Submitted: Yes � No Date of Survey: ' �"'�"��� <br /> Proposed Setbacks: � ! � �� / � <br /> Froat (Lake): .��� � Right Side: -°`' '��' <br /> � � P � �? �����°r,��c,� <br /> Rear (Street : Left Side: <br /> Adjaceot Structures: Wetland: �/t �� <br /> ! r��'' <br /> BuiluinJ Heioht: Def, Hgt, ,Z� '� Peal:Hgt. r�i� � D S�Gh.`����S <br /> Lot Coverage: ,� � � <br /> �N'��.,`�pi7� <br /> ��r� <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: BY� '� <br /> Zon.ing File: # r"` Resolutioa: # �"` Resolution Date: '^'""� <br /> Shoreland Districc: � %� '"'�" <br /> Av;. Setback: Bluff Setback: <br /> /�-J/�- L,o[Coverage: � --` <br /> Et.isting � Proposed� <br /> ,f�, � � �/�-ti s <br /> Hardcover: 0-75 � � <br /> 75-250' 2�T,�e � ° ��� � � <br /> 250-500' O , ' * � � ' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No� Date of Council Approvzl: `'�� <br /> RE��L4RKS (in house): ��Q l�l— �''�'1.�tlaLs St�*�wn) �^-� S Uf�ut`'i A,� � 12.F"�� ����-°, ► <br /> �i�C.c`f�T' S�v� Ue�t. ` r�.�a T l��f� •ry�„ r�,. �V�, , _ <br />