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�HECK. OFF i�IST FOR ISSUANCE �F PE�'VIITS <br /> FOR OFFTCE USE ONLY <br /> ADDRESS OR LEGAL: ��(�D �X <br /> PID: <br /> DESCRIP'1�TON OF WORK: �I `u%`�� <br /> --------------------------p-------------� <br /> --- ---------___--__—__---------------- - <br /> ZO.�i G REVIE`V BY: �� DAT'E APPROVED: (� Z���� <br /> SUILDING REVIE�V BY: DATE.APPROVED: C • a Z -c�.6 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes r� No <br /> PLAN REVIE`V � Yes � No SE�VER CO�iNECTION <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 /> ---------------------_—_-------------------- I <br /> ZONI�IG CI-�CK LIST Zoning District: `�� — <br /> Fire Department: Post O�ce: School District: <br /> � Acres Widch Depch <br /> L,o[ Area:�. ,._ <br /> ( 2, 3 �Y� <br /> Survey Submitted: Yes� v' No Date of Survey: � '� �-'�� <br /> Proposed Setbacks: �l�5f' : <br /> , <br /> Froa[ (Lake}; � 11�� Ct;�Ri�tSide: �UU��� <br /> j► n C' � � � Z <br /> Rear (�: ��' � Left Side: _ � � <br /> S`�liarPnf �rnscnsres: !�� '}' �Ve[land: � ��/9' � <br /> �w,,.,... � <br /> Buil�lin� Hei�t: Def. Hgt. � •J�- Peak Hgt. ��I� � � <br /> Lot Covera�e: _�— /Tp �- (�-�`���-,��J w �T1-� �o a � f- ��. (�1,d�.�5 <br /> Grading: Staff Approval Date: /�1(✓� By: Council Approval Date: <br /> � <br /> Septic: Scaff Approval Date: � ' � � � � �Y� 4`��'� <br /> � n, , S �1 C� �vti/ �j��'r()r�c'� <br /> Zoain� File: �`U � �t �] Resolutioa: # Resolution Date; <br /> i /� � <br /> Shoreland District: � /-� - <br /> Av�. Se[back: Bluff Setback: L.ot Covera;e: <br /> ExistinQ Proposed <br /> 0 <br /> Hardcover: G-75' <br /> 7�-250' <br /> 2�0-560' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Da�e of Cou.ncil Approva.l: <br /> FE�L4RKS (in house): ��-� ►-� �A ''-�^ .: `�_ <br /> . .. ��- <br /> � <br />