Laserfiche WebLink
CHECK OFF LIST FOR ISSUAI�tCE OF PERl�fITS <br /> _ FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: Z55�S j—��. �e�� <br /> PID: <br /> DESCRIPTION OF WORK: (�,�� ,-,� o,`, <br /> ZOrT�i'G REY�`V BY: DATE APPROVED: � - ly-C� <br /> BUII..DI�i tG REV�`V BY: DATE APPROVED: �B �t y -�o <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> pERNIIT Yes �/ No :. <br /> PLAN REVIEW Yes � No SERrIIZ CONNEC'I'ION <br /> STATE SURCHARGE Yes � No WATER CONNECTTON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No STTEINSPECTTON <br /> Number of SAC�Units OTHER (specify) <br /> ZO�tI:vG CHI�CK LIST zoning District: R�' I B <br /> Fire Department: (�4 f c� Post Office: n.c Ch-cc.�. School District: Q i�-C�r�1D <br /> I.ot Area: Sq.ft. /uo G��„( Acres Width Depth <br /> Survey Submitted: Yes_� No Date of Survey: ac�s � <br /> Proposed Setbacks: , <br /> Froat (Lake): SS� Right Side: �J + <br /> Rear (Street): 3�� � Left Side: ((�'� <br /> Adjacent Structures: f{-T-r��c�-c_.� Wetland: 5 L� . <br /> Buildin; Height: Def. Hgt. Q •��-- Peal:Hgt. C9•l�- <br /> Lot Covera�e: �(•(o <br /> Grading: Scaff Approval Date: Q'j - l`-� - t�0 By: �V• Council Approval Date: '� <br /> Septic: Staff Approval Date: � By: — <br /> Zonin� File: # � Resolution: # — Resolution Date: <br /> Shoreland District: y+P�j <br /> Avg. Setback: I� (/� Bluff Setback: N (� L.ot Coverage: <br /> Ezistina Proposed <br /> a <br /> Hardcover: 0-75' <br /> 75-250' �,(L <br /> 2�0-SQO' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No � Dace of Council Approval: <br /> RE�LA.RKS (in house): <br /> 7 <br />