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. �HECK OFF i,IST FOR ISSU.ANCE OF �E�tMITS <br /> � FOR OFFICE USE ONL'Y� . . <br /> ADDRESS OR LEGAL: Z��s ,�'+°�- fZ�J C�e C�it-�P <br /> PID: <br /> DESCR�'I'IO�i OF WORK: o� t <br /> ZOY.J�i IG RE'VIE�V BY: r--Wl�P�w t- ��------------�A'1'E APPROVED: 9 �Z 0 6 <br /> StTILDING RE'�tiV BY: � � , DATE APPROVED; �i -i2 - c?� <br /> FEES TO BE CHARGED:� Misc. Fezs Calculated By: <br /> PERMIT Yes � No <br /> PLAN REVIEtiV � � Yes _�/' No SEtiVER CONNECI'ION <br /> STATE SURCHARGE Yes �/ No tiVATE�RCONNEC'�'ION <br /> INVESTIGATION FEE Yes Na ,/ PARK FEE <br /> SAC Yes No _� STTEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZON'�i TG CHE.CK LTST Zaning District: L� �� . <br /> Fire Department: Post Office: _ School District: • � <br /> Lot Area: Sq.ft. �o�Z�c� Acres I•l� " Width Depch <br /> Survey Submitted: Yes�_ No Date of Survey: D n�_�i c,c? <br /> Proposed Setbacks: ��� . : <br /> FseBc(Lake): l 3� � Right Side: . <br /> B.eaf(Street): ZZ�j Left Side: b2� <br /> Adjacent Structures: �y�� tiVetland: . N �1� <br /> Builclin�Height: Def. Hgt. /�J (I� Peal:Hgt. `-- <br /> Lot Covera?e: ^f (�A <br /> Grading: Staff Approval Date: — By: Council Approval Date: ' <br /> Sep�ic: Staff Approval Dace: — �Y� <br /> Zoaing File: ���9 Resolutioa: # 5 2'i l Resolution Dace: 1�-►3'�Y <br /> Shoreland District: � <br /> Bluff Setback: Lot Covera;e: <br /> Avg. Setback: � Proposed <br /> Eusting <br /> Hardcover: 0-75' Q�.v i d Jswl <br /> 75-250' r <br /> 2�0-500' l�-l� 1��j,,o.�s� <br /> 500-1000' IN <br /> I-ia�dco�er Va-iance Reyuiied: Yes � No Dace ef Co�!neil Approvz: /Z•/?• � <br /> fi.EI�L.�R�iS (in house)• <br />