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. , . <br /> CHECK OFF LIST FOR ISSUANCE OF PERI�IITS <br /> FOR OFFICE USE ONLY • . <br /> ADDRESS OR LEGAL: 2�Sb L ��-c c..� D lz.e�4c-a�� W�-► : <br /> PID: <br /> DESCRIPTION OF WORK: Gr4�h�lOv lrvtz� (.�v�,�v(o s A�c_e_ <br /> ZO�G REY�tiv BY: DATE APPROVED: 3- 3=� <br /> �. BLTLDL�IG REYIE`�BY: � DATE APPROYED; � -3�-�� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes +l No <br /> pI,AN REV�W Yes �/ No SEWE�CO�'ECTTON_ <br /> STATE SURCHARGE Yes � No �VATERCONNECTION <br /> INVESTIGATION FEE Yes No � PARK FEE <br /> SAC Yes No �" SITE �NSPECITON <br /> Number of SAC•Units OTHER(specify) <br /> ------------------_ ----- <br /> ZO�Z�'G CH.ECB LIST zoning Districc: No G Gt'rts✓�►0 <br /> Fire Department: Post Office: School Dstrict: � � <br /> Lot Area: Sq.fc. Acres � Width Depth <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: ,. <br /> Front(Lake): Right Side � - � . <br /> Rear(Street): Left Side• <br /> Adjacent Structures: etland: <br /> Buildin�Heighr. Def. Hgt. al:Hat. <br /> Lot Covera�e: ' <br /> Gradin�: Staff Approval Date: By: Council Approv2l Date: <br /> Sepdc: Staff Agproval Date: By: <br /> Zoning File: # Resolution: # Resoludon Date: _ �. <br /> Shoreland District: <br /> Avg. Setback: Bluff Setba k: Lot Co��ra�e: <br /> � Ezisting Progoscd <br /> Hudcover: 0-75' -- . <br /> . 75-250' _---- <br /> 250-5�0' --- <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: _ <br /> REviAR�iS ('in house): <br /> 7 <br />