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' � CHECK OFF LIST FOR ISSUANCE OF PERI�IITS <br /> FOR OFFICE USE ONLY • . <br /> ADDRESS OR LEGAL: � � ss L��,N srv.^f o�T c�'�- c,oT r3 Q4xx I <br /> PID: � 7 ��7 - 'z� 3�1 vo6s/�3 <br /> DESCRIPTION OF WORB: SI c�N <br /> ZO�G REYJE`V BY: DATE APPROVED: 3 -2 tl-o 0 <br /> �. BL'ILDL1iG REVIE`v BY: n� � � � DATE APPROYED; � � � <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes ✓ No <br /> pI,AI�i REV�W Yes r `No SE�YER COYI�'EG1�ON _ <br /> STATE SURCHARGE Yes ✓ No WATERCONNECTION <br /> INVESTIGATION FEE Yes No P��E <br /> SAC Yes No SITEItii TSPECTION <br /> Number of SAC•Units P�,, s�nw P�'"OTHER(specify) <br /> t=� P�R v r3c: ----- _�______ <br /> zo`�G c�.cx LisT Zoning Districr. c.2-�� . <br /> Fire Department: NI o v�✓J Post Office: �� School Dstrict: • s�K� — � <br /> Lot Area: Sq.ft. /�►� Gt,� Acres ' Width Depth <br /> Survey Submitted: Yes o� No Date of Survey: s����v�su� PCur <br /> f�„ (L,gt...t o�- w a�• <br /> Proposed Setbacks: � ; <br /> � <br /> Front(Lake): Right Side: � � (�/�'� ��� ��� <br /> • +�� �=rt�e� ^-� <br /> Reaz(Street): Left Side: <br /> Adjacent Structures: Wetlaad: <br /> Building Heiaht: Def. Hgt. Peak Hgt. <br /> Lot Coverage: ' <br /> Grading: Staff Approval Date: By: Council Appro�zl Date: <br /> �� Sepdc: Staff Agproval Date: By: <br /> Zonin�File: # � Resolution: # Resoludon Date: <br /> Shoreland District: <br /> Avg. Setback: Bluff Setback: I-0�CO���e' . <br /> . Ezistmo Proposed <br /> Hardcover: 0-75' . <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> RE�+IARKS('in house): � <br /> 7 <br />