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ti <br /> � � • • -, <br /> ' CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: �{1 y V NpR`'�'� SHoi L� Y�R�v L <br /> PID: <br /> DESCRIPTION OF WORK: �lJ p►T�orJ �.o p� <br /> ZONING REVIEW BY: DATE APPROVED: � .2�• g q <br /> BUILDING REVIEW BY: � DATE APPROVED: ,� -2� �'rS <br /> FEES TO BE CHARGED: Misc. Fees �alculated By: � <br /> PERMIT Yes ✓� No <br /> PLAN RE�IEW Yes � No SEWER CONNECTION <br /> STATE SURCHARGE Yes �/ No WATER CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No STTEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECK LIST Zoning District: L R-1(3 <br /> Fire Department: �IAVN� Post Office: w�.o�,.i.O School District: �,,�e sr�N d��P+ <br /> Lot Area: Sq.ft. y OE 1 l`7 Acres .g 2 Width ��o .Z Depth L{00. 3'3 <br /> Survey Submitted: Yes � No Date of Survey: 12 •t.�,•�a <br /> • Proposed Setbacks: <br /> Front(Lake): 3S.3 Right Side: l2� <br /> Reaz(Street): l 3S Left Side: 1 5•4`� <br /> Adjacent Structures: N I 1� Wetland: N �1°► <br /> Building Height: Def. Hgt. (�,k Peak Hgt. 0� �< <br /> Lot Coverage: p.ti� <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File: # Resolution: # Resolution Date: <br /> ��, Shoreland District: <br /> Avg. Setback: Bluff Setback: Lot Coverage: <br /> Existing Proposed <br /> Hazdcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-10�' <br /> Hazdcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS(in house): <br /> 7 <br />