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. CHECK OFF LIST FOR ISSUA.NCE OF PERI�iITS <br /> , FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: l Zz� G A cz,�,:N C��z� <br /> PID: <br /> DESCRIPTION OF WORK: N�,�� �?..�,=S <br /> ZOVPi 1G REVIEW BY: DATE APPROVED: -�• ►3• b� <br /> BUII�DP�1G REV��V BY: DATE APPROVED: -� _ �3•o�( <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PER�tiIIT Yes _� No <br /> PLAi�I REVIEW Yes �/ No SEWER CONNEC'ITON <br /> STATE SURCHARGE Yes —� No WATERCOiVNECTTON <br /> INVESTIGATION FEE Yes 1�To �/ PARK FEE <br /> SAC Yes t/ No SITEINSPECTION <br /> Number of SAC�Units 2 OTHER (specify) <br /> ZO�IING CHE.CK LIST Zoaing Discricc <br /> Fire Department: Post Office: School District: <br /> I.ot Area: Sq.ft. �2,�1�•0`► Acres •�7 Widch /y!' pr�.�P +' Dep[h 30� � <br /> Survey Submitted: Yes oc No Date oE Survey: �• ZI •oy <br /> Proposed Setbacks: <br /> Fron[ (Lake): 19� + Right Side: 33, � <br /> Rear (Street): 1b6� � Left Side: 3Z� t <br /> Adjaceat Structures: N�A `Vetland: N/� <br /> Building Heigb.t: Def. Hgt. 3d � Peak Hgt. 3�' <br /> Loc Coveraoe: 0.K <br /> Grading: Staff Approval Date: 1- (3•�y By: � Council Approval Da[e: <br /> Sep[ic: Staff Approval Date: N IA- By: <br /> Zoning File: # — Resolution: # "' Resolutioa Date: <br /> Shoreland District: nta <br /> Avg. Se[back: Bluff Setback: L.ot Coverage: <br /> Ezisting Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcove� Variance Required: Yes No Date of Council Approval: <br /> REMARKS (in house): <br /> 7 <br />