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CHEC� OFF i�IST FOR ISSUANCE OF PERIVIITS <br /> � FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: �.�Z�v C��1�r �f L� ��? -;�f 1�;�. <br /> PID: <br /> DESCRIPTION OF WORK: ���f��l�F�o ;=:�=�'l r�,('t�',��'�: _ <br /> -----------___-------------------------------- --- <br /> ZO:�I�ti G REVIE'4V BY: ��I�f��(��i i� DATE APPROVED: �?(<�' ������ <br /> BUILDING REVIEtiV BY: DAT'E APPROVED; �� z7 -o � <br /> FEES TO BE CHARGED: Misc, Fees Calculated By: <br /> PERMIT Yes ✓ No �` <br /> PLAN REVIE`V � Yes � No SEWE.R COi�1NECTION <br /> STATE SURCHARGE Yes ✓ No WATERCONNECT'ION <br /> INVESTIGATION FEE Yes No ,/ PARK FEE <br /> SAC Yes No ✓ SITEIltiTSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ----------------------------------------- <br /> Z01II�IG CHE.CK LIST Zoning Districr. L� I �'J� <br /> Fire Department: Post Office: School District: <br /> ,r , <br /> L,ot Area: Sq.ft. 7i�����Z� Sf� Acres f)> �{ ( � Width ��� ��`�� � Depth <br /> Survey Submitted: Yes k' No Date of Survey: <br /> Proposed Setbacks: U( :I � . <br /> Froat (Lake): �ght Side: ` � _ . <br /> Rear(Street): <br /> ��I Left Side: � �� ' 'r ���- ` }E ��,i' r . ; _ ` � l-,71 G������ �- <br /> Adjacent Structures: c' � Wetland: � � � <br /> ��'� � !(� U�"i D����`� <br /> Buildin; Height: Def. Hgt. � Peal:Hgt. ��� �'E'�� <br /> Lot Covera?e: 1 •�b D U <br /> g �f����`s Council Approval Date: i; ' L= 6 f` t.�� <br /> Grading: Staff Approval Date: Y� _�; <br /> Septic: Staff Approval Date: �`� �� BY� <br /> Zonin� File: � ' � ����� Resolutioa: � Resolution Date: �P �D �� <br /> Shoreland District: <br /> AvJ. Setback: (7��/ Bluff Setback: Lo[Covera�e: <br /> Existin� � � Proposed <br /> �I-►'`v�U � {��c`>�-��=,� � <br /> Hardcover: 0-75' ` <br /> � <br /> 75-250' �(I.� o ((�7U� ��` I' <br /> 2�0-500' <br /> 50a-1000' <br /> Hardcover Variance Required: Yes � No Date of Council Approval: ' L� �V <br /> RE`�L4RKS (in house): F'it t t r•� '" � �i '.� " ���(-���' <br />