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• - Ci-iEC� OFF i�IST FOR ISSUANCE OF �ERMITS <br /> ' FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 2501 1�t_-Y � -- 1�►.r� <br /> PID: <br /> DESCR�TiON OF WORK: (Lt IP v4C.0 l.—X �s�i�� �L�'��- <br /> --------- <br /> -------------------------------------:-------------------- <br /> ZO�.�1I�Ii G REVD�W BY: ��--- ______ DATE APPROVED. {,(- 7- 6� <br /> SUILDING RE'VIEti'V BY: DATE APPROVED; � 7-c� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW �� Yes � No SEWER CO�TNECITON <br /> STATE SURCHARGE Yes _� No WA'I'FRCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTTON <br /> Number of SAC�Units OTHER (specify) <br /> ZOYI�1'G CHE.CK LIST Zoning Discrict: No C,✓-f�^�� , <br /> Firo Department: Post OfFice: School District: � � <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: . . <br /> Front(Lake): Right de: � . <br /> Rear(Street): L,eft ide: <br /> Adjacent Structures: Wetland: <br /> Building Height: Def. Hgt. Peal:Hgt. <br /> Lot Coverage: <br /> Gradin;: Staff Approval Date: By: Council Approval Date: ' <br /> Septic: Staff Approval Date: BY� <br /> Zoning File: # Resolution: # Resolution Date: <br /> Shoreland District; <br /> Avg. Setback: Bluff Setba : I.ot Covenge: <br /> EzistinQ Proposed <br /> D <br /> Hardcover: 0-75' <br /> 75-250' <br /> 2�0-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes N Dace of Council Approval: <br /> REv1A.RKS (in house): <br /> � <br />