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� CHEC�' OFF LIST FOR ISSUA.��TCE OF PERII�IITS <br /> _ ` FOR OFFICE USE ONI.Y . � . <br /> ADDRESS OR LEGAL: I y 5 3 �R 2� �2�� <br /> PID: <br /> DESCR�TION OF�ORK: /-��D i � a�! S — �����a�n a� ��l1 c.�1 <br /> . <br /> ZO�G REVIEti'V BY: DATE APPROVED: 2 � S �01 <br /> BUIIrDTir'G REY��BY: . DATE APPROVE.D: Z- s-01. . <br /> FEES TO BE CH.4RGED: biisc. Fees Calculated By: <br /> pERNIIT Yes ✓� No :• <br /> pI,AN REVIEW Yes �/' No Sbw�CO�INECI iON _ <br /> STATE SURCHARGE Yes � No WATERCONNECITON <br /> Ir,'VESTIGATION FEE Yes No P�'►RK FEE <br /> SAC Yes � No SITEINSPECTION <br /> Number of SAC•Units OTHER (specify) <br /> ZO\�L•1IG CH�CK LIST Zonia;Districc: �� ��I ,(�-�v►'� � _ <br /> � <br /> Fire Deparcment: Post Office: School District: • � • <br /> Lot Area: Sq.fr. Acres � Widch Depth <br /> Survey Subritted: Yes No Date of Survey: <br /> proposed Setbacks` � <br /> Froat(La.ke): Riaht Side: � <br /> Rear(Screet): Left Side: <br /> Adjacent Struccures: `Vetland: • <br /> Building Hei�hc: Def. H�t. Peal:Hgt. <br /> Lot Covera�e: <br /> Gradin�: Staff Approval Date: gy: Council Approval Date: <br /> Septic: StafE Approvai Date: By: <br /> Zoaing File: � Resolution: : Resolutioa Dace: . <br /> Shoreland District: <br /> Av�. Setback: Blufi Setback: Lot Cocera�e: <br /> E���� Proposed <br /> Hardcover: 0-?5' <br /> 75-250' <br /> 2i0-500' <br /> 500-1000' - <br /> Hazdcover Variance Required: Yes No Date of Couacil Approval: <br /> gEI�IAR�;S (in house): <br /> 7 <br />