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. CHECK OFF i,IST FOR ISSUANCE OF PERIVIITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS ORLEGAL: s� C�C��..fJtn1 V�l_.w 1�2�vC <br /> PID: <br /> DESCR�ION OF VVORK: �O �T. (��F�� ��: <br /> ZONNG REVIE�V BY: --- -- fi c_'–T DATE APPROVED: � •zc� � � <br /> BUII�DING REVIEtiV BY: � DAT'E APPROVED: �-21�0�. <br /> FEES TO BE CHARGED: Misc, Fees Calculated By: <br /> PERMIT Yes _� No <br /> PLAN REVIE`V � Yes �/' No SE`VER CONNECTION <br /> STATE SURCHARGE Yes —� No �VATERCONNECTTON <br /> INVESTIGATION FEE Yes No c/� PARK FEE <br /> SAC Yes No __� SITEINSPECTION <br /> Number of SAC�Uruts OTHER (sgecify) <br /> ------------------------------------------------------------------------------------ <br /> ZONi�tG CHE.CK LIST Zoning Districr. . <br /> Fire Department: Post O�ce: School Dis[rict: � <br /> L.ot Area: Sq.ft. Acres Widch Depth <br /> Survey Submitted: Yes oL IVo Date oF Survey: D� (=�L.� <br /> Proposed Setbacks: � � . <br /> Fron[ (Lake): ( 2S � Right Side: �v <br /> Rear (Street): Z 5� ' '-` LeEt Side: 1��f � t <br /> Adjacen[ Structures: /d ' Wetland: N ��' <br /> Buildin� Heioht: Def. Hgt. Peal:Hgt. �I �W4u-5 `� �Z �� T GN <br /> G t�y c�-lc <br /> Lot Coverage: {�U(�/-I- <br /> Grading: Staff Approval Date: N�� By: W•C� Council Approval Date: <br /> Septic: 5taff Approval Date: N �� By: <br /> Zoain� File: � �' Resolution: # � Resolution Date: <br /> � <br /> Shoreland District: N b <br /> Av�. Setback: Bluff Secback: L.ot Coverage: <br /> E�istinQ Proposed <br /> 0 <br /> Hardcover: 0-75' <br /> 7�-250' <br /> 2�0-560' <br /> 500-1000' <br /> Ha:dco�'er V�:iance Required: Yes No Datz oE Council Approva!: <br /> REZ�L4RKS (in house): � � � i � � � <br /> - , O � r <br />