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� • . <br /> CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> � ' FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 3z�H rv o�-{ s,.�.�,u; �0 2 . ' <br /> P.�D: — -- -- - <br /> DESCRIPTION OF WORK: �.—u� ,- ,4=r,�n ��c <br /> ZO.�tI�Ti G RE'VIEW BY: DATE APPROVED: �- �Y- �3 <br /> BUILDING REVIE�BY: DATE APPROVED; �-�ti - �3 � <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes � No <br /> PLAN REVIEW Yes �' No SEWER CONNEC'IION <br /> STATE SURCHARGE Yes_L/ No WATERCONNECTION <br /> INVESTIGATION FEE � Yes No ✓ PARK FEE <br /> SAC Yes No � STTEINSPECITON <br /> Number of SAC-Units OTHER (specify) <br /> ZOTTING CH�CK LIST Zoning District: <br /> Fire Department: � Post Office: School District: • � � <br /> Lot Area: Sq�.ft. Acres � Width Depth <br /> Survey Submitted: Yes ✓ No Date of Survey: /n•2 z-�' �- /`1 �/ <br /> Proposed Setbacks: pr�- b � p�� � � � � <br /> Front(I.ake): s'►' � gS's Right Side: o'� � <br /> Reaz(Sueet): i�v�' �ib� t Left Side: �z'= Z 5�* <br /> Adjacent Structures: _,q.�c�-r�� Netland: �/iA . <br /> Building Height: Def. Hgt. d•<< Peak Hgt. <br /> Lot Coveraoe: /4•5 <br /> Gradine: Staff Approval Date: --- By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # — Resolution: # Resolution Date: � <br /> Shoreland District: � <br /> Avg. Setbac c: iv�/.� Bluff Setback: �/�- Lot Coverage: 0+.�� . <br /> � Existin; Ploposed <br /> Hardcover: 0-?5' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hazdcover Variance Required: Yes No � Date of Council Approval: <br /> RENIA.R��S (in house): <br /> 7 <br />