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� , CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY � <br /> ADDRESS OR LEGAL: ��C� ���"i.��.�1 �Z 1'f� ,/���.I1. <br /> PID: <br /> DESCRIPTION OF WORK: N�W t?�,.5 t��=-'"t-Q <br /> ---------------------------------------------------------------------------------------------�----------_--------- <br /> ZONING REVIE`V BY: � DATE APPROVED. �Q• 3 � 7 <br /> BUILDING REVIEW BY: DATE APPROVED: � -Zy - q� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Yes i/ No SEWER CONNECITON <br /> STATE SUR`HARG� Yes � No WATER CONNECITON <br /> � INVESTIGAZ'ION-FEE Yes �_ No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units Ctu.��r �=rLo«� i9�,�,�, OTHER (specify) <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> �ONING CHECK LIST Zoni.ng District: L 2- I(3 <br /> Fire Department: rV\o�N� Post Office: V1/�,0�n►� School District: W c STC�N 1�- <br /> Lot Area: Sq.ft._5_b,(�c�r� Acres (. Z�? Width �tl�1� -�Av� Depth 5 3'1 �t A Vcr <br /> Survey Submitted: Yes_� No Date of Survey: g -��- 9� <br /> Proposed Setbacks: , , , <br /> €�er�t (Lake): l`i S � Right Side: I� N <br /> �ear (Street): 2.�0� {= Left Side: Ib� S <br /> Adjacent Structures: I'V(I�1- Wetland: N�l� <br /> Building Height: Def. Hgt. ,3Z. Peak Hgt. Z.-2.•5 <br /> Lot Coverage: I�I�° <br /> Grading: Staff Approval Date: By: Council Approval Date: I�1��4- <br /> Septic: Staff Approval Date: N 1�4 By: —' <br /> Zoning File: # N 1+4 Resolution: # — Resolution Date: — <br /> Shoreland Dist:ict: �� <br /> Avg. Setback: C�•I�- Bluff Setback: IV(�°i� Lot Coverage: (y`ja <br /> Existing Proposed <br /> Hardcover: 0-75' o 0 <br /> 75-250' Zy.5 0 <br /> 250-500' t i • o`�l <br /> 500-1000' <br /> Hardcover Variance Required: Yes No� Date of Council Approval: <br /> REMARKS (inhouse): R!� s-rM,��i� r�� o�r �-9'�� r - i-o� t-�� .S <br /> /J v b i�v ��v c�(= ,w P�� zow-e - �Zr s t��'� �+��s� v,�� � /3i�cCQ <br /> • 26 <br />