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,�i!�i y N�� <br /> . . <br /> CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: ��Z S �w,<<-�.��cw ��.2�z-�c_�. <br /> PID: <br /> DESCRIPTION OF WORK: hr L w C?�c 5 <br /> ---------------------------______----------------------------- . . <br /> ZO.�tI�i 1G REVIE`V BY: C� DATE APPROVED• S z 3-e S' <br /> BUILDING REV�+W BY: DATE APPROVED: 5 • z 3 •oS <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ,/' No <br /> PLAN REVIEW Yes r/ No SEWER CO�INECTTON ZZ �'�� <br /> STATE SURCHARGE Yes �/ No WATER CONNECTION <br /> INVESTIGATION FEE Yes No � PARK FEE <br /> SAC Yes � No SITEINSPECTION <br /> Number of SAC Units 2 OTHER (specify) <br /> ---------------------------------------------------------------------------------------------------------------------- <br /> ZONI�iG CH�CK LIST zoning Districc: L2-l�4 <br /> Fire Department: Post Office: School District: <br /> LotArea: Sq.ft. 2�,'70� Acres .�g Width 2t�a Depth <br /> Survey Submitted: Yes _� No Date of Survey: �-I• 2�-oS <br /> Proposed Setbacks: <br /> Fron[ (Lake): S�� Right Side: I y 3� r C� <br /> Rear (Street): 5`{� Left Side: 'rjg` � <br /> Adjacent Structures: /�J�_ Wetland: �� <br /> Buildin; Height: Def. Hgt. 2�i• S Peak Hgt. �O <br /> Lot Covera�e: 0.1� <br /> Grading: Staff Approval Date: S- z3•�S By: -T�(t,U��cCouncil Approval Date: — <br /> Septic: Staff Approval Date: /J �q By: <br /> Zonin� F1e: # ��- 3�0� Resolu[ion: # SZ37 Resolution Date: �u•z� - oy <br /> Shoreland Distric[: ,��o <br /> Avg. Setback: Bluff Setback: I.ot Coverage: <br /> E�isting Proposed <br /> Hardcover: 0-7�' <br /> 7�-250' <br /> 2�0-500' <br /> 500-IQ00' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> RE�IA.RKS (in house): <br /> `.,q � <br /> ..�� ,� .�'1j•. } ,�,,:: ., ...:ian... -' ,. F,.� �.� <br /> L� �.�. _ (� �`,���V'" <br /> 7 <br />