Laserfiche WebLink
CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> A,DDRESS OR LEGAL: 3SSz{ C_YR-►�- A V 2 <br /> PID: <br /> DESCRIPTION OF WORK: ���c. <br /> ZO.�tIvi G REV�W BY: „`. DATE APPROVED: �- Z� -� S' <br /> BUII�DING REVIEW BY: DATE APPROVED: �, •Z,l-o � <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ,/ No <br /> PLAN REVIEW � Yes No SEWER C0�INECTION <br /> STATE SURCHARGE Yes � No WATERCONNECTION <br /> INVESTIGATION FEE Yes No �' PARK FEE <br /> SAC Yes No � • SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZO��TG CH�CK LIST Zoning District: <br /> Fire Department: Post OfFice: School District: <br /> Lot Area: Sq.ft. I 3�'1�� Acres , 3 Width �O o Depth 1 3`f•� <br /> Survey Submitted: Yes�_ No Date of Survey: 6-�o •O S <br /> Proposed Setbacks: <br /> Front(Lake): 33•�6 Right Side: 21.5 <br /> Reaz(Sueet): �2� Left Side: �o � <br /> (�ec.tc s't1+t�/L � �'0 (o <br /> Ad;acent Structures: c� S' Wetland: N�A °•�` `� <br /> Buildin;Height: Def. Hgt. �I/� Peak gt. — <br /> L.ot Coverage: ��.b°7� <br /> Grading: Staff Approval Date: /�(�r4 By: Council Approval Date: <br /> Septic: Staff Approval Date: n(��q By: <br /> Zon.ing File: # — Resolution: !� Resolution Date: <br /> Shoreland District: /v c� <br /> Avg. Setback: Bluff Setback: L.ot Coverage: <br /> Existing Proposed <br /> Hazdcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REviA.RKS (in house): <br /> � <br />