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, CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: l 3�31 N o RTl-4 A R� �R� � <br /> PID: <br /> DESCRIPTION OF WORK: ��,(L�-7V Po�-c.�� - <br /> -------------------------------------------- -- <br /> ------------------------------------------------:-------------------- <br /> ZO�1ING REV�W BY: � DATE APPROVED• �-l Z-5 � <br /> BUII.DING REVIEW BY: DATE APPROVED: $- �-i- �,� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Yes J' No SEWER COrfNECTION <br /> STATE SURCHARGE Yes �/ No WATER CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC � Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECK LIST Zoning District: (,2-i3 <br /> Fire Department: W�,o��n Post Office: vV•�v� School District: 1,,.��s rorv lch <br /> Lot Area: Sq.ft. �1�1, z,c�.� Acres 1•t'3 Width 1 RlU3�u v�.-2 Depth <br /> Survey Submitted: Yes�C_ No Date of Survey: on� (t l o-�-3•g� <br /> Proposed Setbacks: <br /> Front(Lake): Right Side: <br /> P�N�� <br /> Rear(Street): Left Side: <br /> Adjacent Structures: AZ-r�c�1-�.� Wetland: N►A <br /> Building Height: Def. Hgt. o• �`- Peak Hgt. - <br /> Lot Coverage: o.I� <br /> Grading: Staff Approval Date: - By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # — Resolution: # — Resolution Date: <br /> Shoreland District: �(�5 <br /> Avg. Setback: !�•l� Bluff Setback: /' Lot Coverage: O•L� <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hudcover Vaziance Required: Yes No Date of Council Approval: <br /> REMARKS(in house): <br /> 7 <br />