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� � CHECK OFF LIST FOR ISSUANCE OF PER�I�IITS • <br /> � FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: S 2 S !�v rv't-L-',2 ��k SS � <br /> PID: � <br /> DESCl�2IP'ITON OF WORK: a� ` . � <br /> ZONING REV]E��BY: ,, ~ � Y DATE APPROVED: I O - 5 -S�3 <br /> BUJI,DT�i tG RE V I E�'V B Y: __� � �//�. DATE APPROVED: . . <br /> . ---_--------------------- <br /> �"r,ES TO BE CHARGED: - - Misc. Fees Calculated By: � � <br /> PERMIT Yes v" No ' <br /> PLAN REV�W Yes v No SE`V�R C0�INECTiON <br /> STATE SUR`H1��Gr Yes v No ti�IATER CO�TECTION <br /> IivVESTIGAT70N-�EE Yes No PA�tK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONIItiTG C�CK LIST zoning District: (�(Z-1(3M----------------------- ------ � ---- <br /> Fire Deparmienr. nr rw Post Office: �,,,,�a,�,—�,q.7yq. School District: �(l,p� � <br /> Lot Area: Sq.fr._ n!'v �;�!,�o+�cAcres — tiVidth — --- � <br /> Depth <br /> Survey Submitted: Yes�_ No Date of Survey: (�N �=r � <br /> Proposcd Setbacks: <br /> t <br /> Froat (Lake): , � �t�j Right Side: ��C7 " <br /> Rear (Street): ?.�O . Left Side: Z�� <br /> Adjacent Structures: � b� tiVetland: � <br /> Building Heioht: Def. Hgt. • Peak Hgt. - <br /> Lo[Coverage• <br /> Gradin�: Staff Approval Date: � By: Council Approval Date: <br /> Septic: Staff Approval Date: gy; • � . <br /> Zoaina File: � Resolution: # Resolution Date:� � <br /> Shoreland Dis�ict: � � <br /> � Avg. Setback: Bluff Setback: Lot Coverage: � <br /> � � ' E���� Proposed � <br /> Hardcover: 0-?5' <br /> 75-250' . - - <br /> 250-500' . . <br /> 500-1Q00' <br /> Hardcover Vuiance Required: Yes No Date of Council Approval: <br /> . � <br /> REI�ZAR.KS ('in house): � <br /> � _ . • . <br /> : J1i ` 26 <br /> . �t- . . <br />