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CHECK OFF LTST k'OR XSSUANCE OF PERII�LITS <br /> � FOR OFFICE USE ONLY <br /> ' ADDRESS ORLEGAL: _ '2�`�fd N0211-� .cSE4OtZ� �R1VCs . <br /> PID: <br /> DES CRIP'I'ION OF WORK:, STp{Z � <br /> ZOYlNG REV1E'�BY• -- =DATE APPROVED: 7. L� -�S£3 <br /> BUII.DING REVIEW BY: � <br /> . . DATE APPROVED: 7-2Sg,•.gfi <br /> FEES TO BE CHARGED: - � Misc. Fees Calculated By: ~� <br /> PEFtMIT Yes t/' No ' <br /> PLAN REV�W Yes �/' No SEWF��CO�TNECTION <br /> STATE SUR`HARG c ye,s_IC No WATER CONNECTION <br /> INVESTIGAZ'ION-FEE Yes No PARK FEB <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units � OTHER (specify) <br /> ____��---------------- - ---- <br /> ZONING CHECK LIST zoning Districc: �fo � �� �� <br /> , � �i . <br /> Fire Department: Post Office: School District: ' ' <br /> Lot Area: Sq.ft. Acres Widch . Depth <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: . <br /> Front (Lake): . Right Side: . � <br /> Rear(Street): Left Side: <br /> Adjaeent Struccures: Wetland: <br /> Building Heiaht: Def. Hgt. Peak Hgt. � <br /> Lot Coverage: <br /> Grac�iag: �Staff Approval Date: � � � By: Council Approval Date: ' <br /> Septic; Staff Approval Date: gy; � . <br /> Zoni.ng File: # - Resolution:� Resolution Date:� <br /> Shoreland Dis�-ict: � � <br /> Avg. Setback: Bluff Setback: LotCoverage: � <br /> ' E��g Proposed � � <br /> Hazdcover: 0-75' <br /> 75-250' . . • • <br /> 250-500' . . . <br /> 500-1000' <br /> . Hudcover Vaziance Required: Yes No Date of Council Approval: <br /> . � <br /> RENLA�2KS('m house)s_�.K- d� C7.z�a�/t.. P� s ec.r ��•., �o . 0 3 g.,r3� S � <br /> z __ , . . <br /> • y'°'�ZA., - 26 <br />