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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> , ` FOR OFFICE USE ONLY � ( <br /> ADDRESS OR LEGAL: t �'j Z� �o x S►t��r ! <br /> , <br /> PID: � <br /> DESCR�'TION OF WORK: `4p�> r)p�/ �Zc.-�i-t.�vt,az <br /> , <br /> ------ -------------------- ---- -------------------------------------------------------------------- ; <br /> Z0�1G REVIEW BY: DAT`E APPROVED: �•zco� �� ! <br /> BLTILDIPtG REVIEW BY: DATE APPROVED; 7 •Z.� -5 9 I <br /> �� <br /> ------------ -------------__---_---____ ____----------------------------------------------------------------- � <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: � <br /> PERMIT Yes � No <br /> PLAN REVIEW Yes � No SEWER CONIVECITON <br /> STATE SURCHARGE Yes ,� No WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZO�IG CH�CK LIST Zoni.ng Districr. R�L- 1� <br /> Fire Depar[ment: l.o�Jf, LA+�c�- Post Office: l_otico Lva�ce School District: ��,o,�o <br /> I.otArea: Sq.ft. /�o crrPwGe Acres -- Width _ Depch – <br /> Survey Submitted: Yes vc No Date of Survey: II <br /> Proposed Setbacks: <br /> Front(Lake): ��� 3 Ri?ht Side: �'� <br /> Rear(Street): Z `c�Z Left Side: �Z <br /> Adjacent Structures: F�7�f1�� Wetland: .�v/�J- <br /> Buildin� Height: Def. Hgt. O,K Peak Hgt. � <br /> Lot Coverage: �� ' <br /> Grading: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: '— By: <br /> Zoning File: # — Resolution: # Resolution Date: � <br /> Shoreland District: /�/v <br /> Avg. Setback: Bluff Setback: L.ot Coverage: <br /> Ezisting Proposed <br /> Hardcover: 0-75 <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS (in house): <br /> 7 <br />