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• 4 • <br /> ' - . CHECK OFF LIST FOR ISSUANCE OF PERNIITS <br /> FOR OFFICE USE ONLY • <br /> ADDRESS ORLEGAL: ZS��S c_i TTc.� oRc t-�-►4� w�4 y . <br /> PID: ' <br /> DESCRIPTION OF WORK: rv�W (� S ' <br /> ZO.�tI�i G REV�W BY: ~~~_� DATE APPROS�ED: /r/z2�QS <br /> BUII.DPTG REV�W BY: � DATE APPRO`ED; �,/��-z /g� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes �/' No <br /> PLAN REV�W Yes c� No SEWER COIVNECTION <br /> STATE SURCHARGE Yes � No WATERCONNECITON <br /> INVESTIGATION FEE Yes No � PARK FEE <br /> SAC Yes ci No � ° STTEINSPECTION <br /> Number of SAC-Units 1 OTHER (specify) <br /> ZOY�TG CH�CB LIST Zoning District: L Q-�� <br /> Fire Deparcment: (,CN h (i4�l,c Post Office: C�n3� V4�c: School District: Q- �N 6 <br /> Lot Area: Sq.ft. Acres 2•Z � Width /R��t�/L �p� 3 7 I .7 � <br /> Survey Submitted: Yes oC No Date of Survey: I!-ly'9`j <br /> Proposed Setbacks: � <br /> Front(Lake): I'7�� { Right Side: � ��� <br /> Reaz(Street): 11�9 � '} Left Side: 3�� <br /> AdjacentStructures: �J//f- Wetland: N/14� <br /> Buildin�Height: Def. Hgt. 3o Peak Hgt. 3S' <br /> Lot Coverage: /�1 I� � <br /> Grading: Staff Approval Date: l I •L 2 • 9q By: � Council Approval Date: <br /> Septic: Staff Approval Date: _ �+! �A By: <br /> Zoning File: # — Resolution: # Resolution Date: <br /> Shoreland Disuict: v�5 <br /> Avg. Setback: o•1� Bluff Setback: N I/} Lot Cover�,°e: N/A. <br /> Ezisting Proposed <br /> Hazdcover: 0-75' � <br /> 75-250' z 3�l� <br /> 250-500' <br /> 500-1000' <br /> Hazdcover Variance Required: Yes No Oz. Date of Council Aoproval: <br /> REMARKS ('in house): - <br /> 7 <br />