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• , � CHECK OFF LIST FOR ISSUANCE OF PERII�IITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: �{ l v�3 �-4��K wo��p t2-r�o4�0 <br /> PID: <br /> DESCRIPTION OF WORK: _ ��1 t� � n,p,J <br /> ZOivING REVIEW BY: �%� � _- _� .�__ ~ DATE APPROVED: i;,H-L~-------� <br /> BUII.DING REVIEW BY: DATE APPROVED: �`�7 S�� <br /> ��-------------------------------------- -- <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes ci' No <br /> PLAN REV�W Yes v� No SEWER CONNECTTON <br /> STATE SUR`HARG� Yes �/ No WATER CONNECITON <br /> INVESTIGAZ'ION-FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ---------------------------------------- ------ <br /> ZONING CHECK LIST Zoning Districr. � �" - �' <br /> � �� � <br /> Fire Department: ����� �; ����.,��� Post Office: � ������� ��' School District: ��'��!,�,: � a�'�f����,`.� <br /> � � � � <br /> Lot Area: Sq.fr. � �� � � Acres � � Width � � � :,,. � <br /> _ _ �' Depth <br /> Survey Submitted: Yes � No Date of Survey: �' �.' � `i <br /> Proposed Setbacks: . � : <br /> Front (Lake): � �J Right Side: ' �J <br /> Rear (Stree[): � ,� / � Lefr Side: � . ~ <br /> Adjacent Structures: j' Wedand: � � <br /> , <br /> Building Height: Def. Hgt. 'U . � Peak Hgt. -?� <br /> , � _ . <br /> Lot Coverage: i� � � , � �, � -� ���' � i � <br /> Grading: Staff Approval Date: 't u� 2�:� -�i 1 By: � �- Council Approval Date: j � G'-? <br /> Septic: Staff Approval Date: /l.� j� By: <br /> Zoning File: # Resolution: # �'� /� Resolution Date: ' �%i��� <br /> —�� <br /> Shoreland DisL-ict: �I i� ', <br /> Avg. Setback: ;��; Bluff Setback: "� jr; LotCoverage: ��,`� �'�� <br /> - Eziscing � Proposed <br /> Hardcover: 0-75' �1;;'�; � �;j',` <br /> 75-250' ��t�r. , S✓,, . <br /> 250-500' �,�`�l� � l� <br /> � 500-1000' y.0� � ���''- <br /> ��` <br /> Hardcover Variance Required: Yes y No Date of Council Approval: ' � �i ' f <br /> RE�I�ARKS (in house): <br /> • 26 <br />