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, . CHECK OFF LIST FOR ISSUANCE OF PERI�IITS <br /> FOR OF CE USE ONL,Y • <br /> ADDRESS OR LEGAL: � 3 q 9 (�o�r �r i V 4. <br /> PID: o� - i�-�- 23 Z o011. <br /> DESCRIPTION OF WORK: 2"'� Sfor i ) <br /> ZO��'G REVIE`V BY: a..� -------- DATE APPxO`'ED: s z 0' <br /> BL�DLIIG REY�`V BY: DATE APPROVID; z • r� -�a <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes ,/' No <br /> pLAN REV�W Yes � No SE�VER CO�'ECTION <br /> STATE SURCHARGE Yes � No �VATERCOi�1�v'ECTION <br /> INVESTIGATION FEE Yes No v� PARK FEE <br /> SAC Yes No [� ST�'EL\TSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZO�Z�G CH�CK LIST Zoning Districr. �. <br /> Fire Department: M o Post Office: SS3 6 y . School D:s�ict: �Z 7 7 <br /> Lot Area: Sq.ft. 2 Z I 0� 0 Acres � � � � Width 1�1�- Depth Z-��'(`�`� �' <br /> Survey Submitted: Yes x No Date of Survey: / Z 2 Z q <br /> Proposed Setbacks: � ! <br /> Front(Lake): $� Ri�ht Side: �2 <br /> Rear(Street): N� Left Side: �a , <br /> Adjacent Structures: �� tiVetland: NA <br /> , , yo� c►o.�-� �-. W.���� <br /> Building Heijht: Def. Hgt. 3 Peak Hgc. <br /> Lot Covera�e: 2 895 no c1^a�N�• <br /> Gradin�: Staff Approval Date: /✓�� By: Council Appro�-�1 Date: <br /> Septic: Staff Agproval Date: /✓�� By: <br /> Zonin�File: # ZSS2– . Resolution: # Resolution Date: 2 � 0O <br /> Shoreland District: L It� � � <br /> Av;. Setback: v��+�c�e- Bluff Setback: N I/� LotCo��ra�e: !�/L <br /> Ezistmg Progosed <br /> Hardcover: 0-75' 0 � <br /> 75-2�0' —���. (30.o g) y/8 �30.04� <br /> 2�0-Sd0' 7~Z7s 30� 727 30� <br /> SQO-1Q00' <br /> Hardcover Variance R:quired: Yes� No Date o`Coueci Approval: ZI j�Id� <br /> RE�LA_RKS ('ln house): <br /> 7 <br />