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� �CHECK OFF i�IST FOR ISSUANCE OF �'ERMITS <br /> • FOR OFFICE USE ONLY . <br /> ADDRESS OR LEGAL: , �s d rv►�p�=2���e _ <br /> PID: <br /> DESCR�TION'OF WORK: �<<T,e.�.o..� ���'s���p�- <br /> ------------------ --------- --_--_---_------------------------------------------------ <br /> ZON .Ni G REVIE`V BY: l DATE APPROVED: <br /> SUII�DING REVIEtiY BY: DATE APPROVED; q- 6-o b � . <br /> FEES TO BE CHARGED: Misc. Fees Catculated By: <br /> PERMIT Yes r� No <br /> PLAN REVIEtijI � Yes No � SEti'�ER CONN'ECTION <br /> STATE SURCHARGE Yes -�` No WATERCONNECTION <br /> INVESTIGATION FEE Yes No ,/� PARK FEE <br /> SAC Yes No t/ STTEINSPECTTON <br /> Number of SAC�Units OTHER (specify) <br /> ----------------------------- <br /> ZOYI�TG CH�CK. LTST Zoning District: /U v G!-/�/6 Q , <br /> Fire Department: Post OfFice: School District: • � <br /> Lot Area: Sq.ft. Acres Widch Depth <br /> Survey Submitted:� Yes No Date of Survey: <br /> Proposed Setbacks: . . <br /> Froat(Lake): Riaht Side: � <br /> Reaz(Street): Left Side: <br /> Adjacent Strucmres: tland: <br /> Buildin, Height: Def. Hgt. eal:Hgt. <br /> Lot Coveraoe: <br /> Gradino: Staff Approval Date: y: Council Approval Date: ' <br /> Septic: Staff Approval Date: � � <br /> Zooing File: (# Resolutioa: # Resolution Date: _ <br /> Shoreland District: <br /> Av�. Setback: Bluff Setback: Lot Covera�e: <br /> Ecisting Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> IIardcover Variance Required: Yes No Dacz oE Council Appr�val: <br /> RE1��L4RKS (in hou5e): <br />