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. CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> ' FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: W�S (7yc,Fo2� C�u� <br /> PID: <br /> DESCRIPTION OF WORK: SI-k�� <br /> ZONING REVIEW BY: DATE APPROVED: 9 •i 3-9 9 <br /> BUII.DING REVIEW BY: DATE APPROVED: � . z.3 -4�i <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes � No <br /> PLAN REVIEW Yes c� No SEWER COrfNECTION <br /> STATE SURCHARGE Yes � No WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECK LIST zoning District: LR-1/; <br /> Fire Department: (ivNlo U41Gr: Post Office: �`�r (�L� School District: D/2-�9�V O <br /> Lot Area: Sq.ft. N v C J�FqrKG�cres --- Width Depth — <br /> Survey Submitted: Yes� No Date of Survey: ��S-2Z •6t I <br /> - Proposed Setbacks: <br /> Front(Lake): 3'7v Right Side: Z�(� � <br /> Rear(Street): Z-'�° � Left Side: 1 70� f- <br /> Adjacent Structures: l`f0� � Wedand: l� l A <br /> Building Height: Def. Hgt. C� .l�- Peak Hgt. C�.l� <br /> Lot Coverage: N �l� <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> �'�L�� Septic: Staff Approval Date: By: <br /> Zoning File: # Resolution: # Resolution Date: <br /> Shoreland District: y�� <br /> Avg. Setback: c9•k- Bluff Setback: N��! LotCoverage: A �C <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> . 250-500' �'<< <br /> 500-1000' <br /> Hazdcover Vaziance Required: Yes No 0� Date of Council Approval: <br /> REMARKS (in house): <br /> 7 <br />