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, CHEC� OFF i�IST FOR ISSUANCE OF i'ERIVIITS <br /> . FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: / G° � C� �-� /L'�-k ��J��'�`� <br /> PID: <br /> DESCRIP'I'ION OF WORK: , /� -. � �i`> �'� � �' �� � �e � �' <br /> �(ose� <br /> ----------------- ------------------�-------� - - w�� <br /> --- ------------- ----- DATE APPROVED• '�� h� /cu> <br /> ZONIV'G REVIEW BY: (;��{� <br /> SUILDING REVIEtiV BY: DATE APPROVED: n�S� <br /> FEES TO BE CHARGED: Misc. Fees Caiculated By: <br /> PERMIT Yes No <br /> PLAN REVIEtiV � Yes No SEWER CO�TNECI'ION <br /> STATE SURCHARGE Yes No WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEII�TSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ------------------------------------------------- 1 <br /> -� _ <br /> Z01IIi�IG CHE.CK LIST Zoni.ng District: L t <br /> Fire Departmenr, Post Office: School District: <br /> Lot Area; S ft. �' Z 5 I(.� `�.cres Width Depth <br /> q �.�_� ���r'G4.c.r i✓! )� I��S��J� S �]GW_� �/.ShhC/ <br /> Survey Submitted: Yes No �� Date of Survey: Orck, <br /> Proposed Setbacks: <br /> Front (Lake): Right Side: <br /> Rear(Street): Left Side: <br /> Adjacent Structures: ��,��'�- �Vetland: <br /> Buildin� Height: Def. Hgt. Peal:Hgt. <br /> Lot Covera;e: <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: !��� BY� w�- <br /> Zoning File: �# Resolutioa: � Resolution Date: <br /> Shoreland Districc: <br /> Avg. Setback: Bluff Setback: L,ot Coverage; <br /> Eusting Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 2�0-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> RE`L4RKS (in house): <br />