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� CHEC�i OFF LIST FOR ISSUA.�'�TCE OF PERtiIITS <br /> � - FOR OFFICE USE ONL.Y . ' . <br /> ADDRESS OR LEGAL: 25�i hS-��1 cp,�►.� � '(Lo R-� <br /> PID: <br /> DF,SCRIP'TION OF�ORK: a o� <br /> . <br /> Z Or�G REVLEti�BY: D�TE APPROV�.TD: �i( -23 -c� <br /> BUILD�'G REV7E'4�BY: D�.TE APPROYF�: Y—'z3._'�� <br /> FEES TO BE C�iARGED: �,iisc. Fees Calcuiated By: <br /> PERMIT Yes c/ No :• <br /> PLAN REVIEW Yes r/� No SEWF.R COiWEG"TION <br /> STATE SURCHARGE Yes � No ��ATEIZCONYECI'ION <br /> I�,'VESTIGATION FEE Yes No PARK FEE <br /> SAC Yes � No STTEINSPECTTON <br /> Number of SAC�Units OTHER (specify) <br /> ZO\`L�IC CH�CK LIST zonin�Districc: (�CZ�11(3 . <br /> Fire Department: (�ns� C��C.d Post Ofuce: % School District: D�-on�� � <br /> Lot Area: Sq.fc. �vd GI-1�W�Acres � Widch Depth <br /> Surve;� Sub.:.itted: Yes OL No Date of Survey: � P�L� <br /> Propased Setbac?cs: � � � <br /> F,on[(Lake): I 3Z �' Ri�h�S;de: �(,g — <br /> � � � <br /> Rear (Screet): � v S' f- I.efr S:de: � 6 � — <br /> Adjacent Structures: Z�i � �Vetland: N �� � • <br /> Buildin� Hei�hc: Def. H�t. `— Pe�':H�t. —' <br /> I,ot Covera�e: — <br /> Gradin�: Stafi Approval Date: '—"' By: Council Approval Date: <br /> Septic: Staff Approval Da�e: —' By: <br /> Zoain� File: � � Resolution: r Resolution Date: • <br /> Shoreland District: /v-� <br /> Av�. Setback: Bluf Setback: LotCo�'era�e: <br /> E���? Proposed <br /> Hardcover: 0-7�' -- <br /> 7�-250' - <br /> ti0-5(}0' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Aoproval: <br /> gEI�IARb'.S (in house): <br /> 7 <br />