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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 3S,�o �vy Pc��c�. <br /> PID: <br /> DESCRIPTION OF WORK: �Z�Pu�c.� (2.�oF Z�sses <br /> ZOrT�i 1G REV�`V BY: DATE APPROVED: S-2-0 3 <br /> BiTII.DING REVIE`V BY: ��,,�, C DATE APPROVED: s .Z-a 5 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes �/ No <br /> PLAN REVIEW Yes �/ No SEWER CONNECITON <br /> STATE SURCHARGE Yes � No WA'I'ERCONNECTION <br /> -�INVESTIGATION FEE Yes x No PARK FEE <br /> SAC Yes No ,/ SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ---------------------------------------------------------------------------------------------------------------------- <br /> ZOi�1Ii�IGCH�CKLIST ZaningDistrict: C.2-�L <br /> Fire Department: Post o�ce: School District: <br /> �� <br /> Lot Area: Sq.ft. .4►1 A� I�,��lo"� Width �'S'� Ar 5 f�1v� Depch <br /> Survey Submitted: Yes No Date of Survey: 2-S-o S <br /> Proposed Setbacks: <br /> Freat (Lake): �la� Right Side: $•Z S (� i o� �o (�/L��?oseJ �oR�vw�-5 <br /> � <br /> P�e�r (Street): _ �y/� Left Side: I t�•q� <br /> Ad;acent Structures: /���- Wetland: /v!� <br /> Buildin� Heioht: Def. Hgt. 3� Peak Hgt. 33 <br /> Lo[ Covera�e: ivo erfiwvGe <br /> Grading: Staff Approval Date: n�/c. By: Council Approval Date: <br /> Septic: Staff Approval Date: N g By: <br /> Zoning File: # 05•3o��q Resolution: # Resolu[ion Date: �-Zf3-C�S <br /> Shoreland District: v,r5 <br /> Avg. Setbac�yA2�,�„�c..� Bluff Setback: ,v//+ L.otCoverage: <br /> Ezisting Proposed <br /> Hardcover: 0-75' O 3Z.� .�- `-1`-�•3`i <br /> �s-Zso� y�.yy <br /> Zso-soo� <br /> 500-1000' <br /> Hardcover Variance Required: Yes X No Da[e of Council Approval: 3- Ztd-oS <br /> RENIARKS (in house):� W0t21�. �� w�0 �,D�1�.� <br /> 7 <br />