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CHECjK OFF i,IST FOR ISSUANCE O�' PERIVIITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: l OU l �l�l�`�� � l����' ���-- �I U,�- <br /> PID: <br /> DESCRIl'TTON OF WORK: �U� � l�L-e=�- <br /> ---------------------------------------------L__Ofo-- <br /> --- ------�-- -- ---------- DATE APPROVED: � -t <br /> ZO�G REVIE�V BY: <br /> BUIZDING REYIE`V BY: DAT'E APPROVED: .�- I Z -ob <br /> FEES TO BE CHA.RGED: Misc, Fees Calculated By: <br /> PERMIT Yes � No <br /> PLAN REVIEtiV � Yes —� No SEtiVER CO1�INECITON <br /> STATE SURCHARGE Yes � No WATERCONNECTTON <br /> INVESTIGATION FEE Yes No c/ PARK FEE <br /> SAC Yes No � SITEINSPECTION <br /> 1�Tumber of SAC�Units OTHER (sgecify) <br /> ----------------------- <br /> ----------------------------------------� -r�-,-------------------------- <br /> ZONI�IG CI-i�CK LIST zoni.ng Districc: rZ <br /> Fire Department: Post Office: �1 J�--f?f ��� School District: <br /> Lot Area: Sq.ft. �� Y/l�� Acres Width Depth <br /> Survey Submitted: Yes No JC Date of Survey: 'Z�. �P�,�_�� ��� <br /> ' �n/0 T /j,E�J. , <br /> Proposed Setbacks: � � <br /> Froat(Lake); Right Side: � �/ <br /> � l�: <br /> Rear(Stree[): �L� Left Side: <br /> Adjacent Structures: 19-:T���� Wetland: � /� <br /> Builuin� Heioht: Def. Hgt. �//L Peal:Hgt. ��� <br /> Lot Coveraje: � I C�� v <br /> Gcadina: Staff Approval Date: Gv (� By: Council Approval Date: <br /> Septic: Staff Approval Date: � �� �>`�� BY� �'� `� /`��� <br /> Zoning File: # � Resolution: � — Resolution Date: �� <br /> Shoreland Districc: � ��1 '�U�iU� <br /> Av�. Setback: �v�} Bluff Setback: /t///-� 'Lot Cpv�rage: <br /> Eustino Proposed <br /> Hardcover; 0-75' <br /> 75-250' <br /> 2�0- <br /> � 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> RE`�LA.RKS (inhouse): � �?�c.c� c; ,sn� ��� c.s�-n� s���� <br /> 0 r�*-� <br />