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, <br /> CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: Z 6 Z 5 NO 2'r'7-� s H o�t= t�2 <br /> PID: �4a� <br /> DESCRIPTION OF WORK: (��-r�c i-��ip C A�t�.�a c� ��� Z�� S-+-o2t, + ��,,,�,,�� <br /> ZO�IG REV�W BY: DATE APPROVED: f, -z3•a`( <br /> BUII.D .ri tG REVIE`V BY: DAT'E APPROVED; 1� •z.3• oy <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: , <br /> PERiV1IT Yes � No <br /> PLAl�t REVIEW Yes � No SE'WER CONNECTION <br /> STATE SURCHARGE Yes No WATERCONNECIZON <br /> TNVESTIGATION FEE � Yes No PARK FEE <br /> SAC Yes No STTEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZO�TING CHE.CK LIST Zonino District: L2-�A , <br /> Fire Department: Post O�ce: School District: � <br /> Lot Area: Sq.ft. $6, 12�1 Acres i.g'1 � Width Depth <br /> Survey Submitted: Yes_ (� No Date oE Survey: 1 • 21 - oy <br /> Progosed Setbacks: , <br /> Front(Lake): �S Right Side: 1 �t S� <br /> Reaz(Street): 23`I` } Left Side: �?� <br /> Adjacent Structures: �-�� � `Vetland: �S� <br /> Building Hei;ht: Def. Hgt. o.lc Peak Hgt. - <br /> Lot Covecaoe: N �Q <br /> Grading: Staff Approval Date: C�.l� By: Council Approval Date: <br /> Septic: Scaff Approval Date: N ►A By: <br /> Zoni.ng File: # oy-3c�� Resolution: �# Resolutioa Date: � <br /> Shoreland District: v�5 <br /> Avg. Setback nt 1d Bluff Setback: /�/�la I.otCoverage: N�A. <br /> Existing Proposed o.�j`z,oN' <br /> Hazdcover: 0-75' i 4°?o (�l � � ��+Gw'��"� <br /> 75-250' 33•3� 2��7 7�� �5+o Z 5� �^'' <br /> � ZI�n /v� <br /> 250-500' <br /> 500-1000' <br /> Hazdcover Variance Required: Yes�_ No Date of Council Approval: <br /> REMARKS (in house): <br /> 7 <br />