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CHEC� Ok'F i�IST FOR ISSUANCE OF �ERMITS <br /> . FOR OFFICE USE ONLY <br /> ADDRESS ORLEGAL: ►y l�5 P�4�z�c �(J2 <br /> PID: <br /> DESCRIP'1'TO�T OF WORK: �?x ww�ec- �a-n-� w�-� �'�'�— <br /> ZO�.�TP�i G REVLEtiV BY: r~ -- — DATE APPROVED: �I- 5-o � <br /> SUII�DING REVIE�� B . DATE AP P R O V ED; y_ �o�b � <br /> FEES TO BE C�IARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓� No <br /> PLAN REVIEtiV �� Yes � No ✓ SEWE.R CO�TNECTION <br /> STATE SURCHARGE Yes _� No WATERCONNECI'ION <br /> INVESTIGATION FEE Yes No _�� PARK FEE <br /> SAC Yes No � SITEINSPECTTON <br /> Number of SAC�Units OTHER (specify) <br /> ZO�tI1IG CH�CK LIST Zoning District: C'it . <br /> Fire Deparcment: Post Office: School District: � � <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes No ate of Survey: <br /> Proposed Setbacks: . . <br /> Froat(Lake): Right Side: <br /> Reaz(Street): Left Side: <br /> Adjacent Structures: W tland: <br /> Buildin� Heieht: Def. Hgt. ak Hgt. <br /> Lot Coveraae: <br /> Gradin;: Staff Approval Date: Council Approval Date: ' <br /> Septic: Staff Approval Date: BY• <br /> Zonin; File: !# Resolution: # Resolution Date: <br /> Shoreland District: <br /> Avo. Setback: Bluff Setback: L.ot Covera?e: <br /> Ezistin� Proposed <br /> 0 <br /> Hardcover; 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Da[e oE Council Approval: <br /> REl�L4RKS (in house): <br /> � <br />