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CHECK OFF i�IST FOR ISSU.ANCE 4F �ERMITS <br /> FOR OFFICE USE ONLY . . <br /> ADDRESS OR LEGAL: , �ZS PA�iZ��w oo'� �-a^� �= <br /> PID: <br /> DES CR�TION OF WORK: t�ec:� (Lt�P��w-°��s — sn� S�z—P <br /> ZOYIPIG RE'VIE'4Y BY: ---- - w__... DATE APPROVED: �0•3-o� <br /> SUII�I?Il�tG REVIE�V BY: DATE APPROVED; � o• 3•o �•. <br /> FEES TO BE CHARGED:� Misc. Fezs Calculated By: <br /> PERMIT Xes _� N'o <br /> PLAN REVIEtiV �� Yes _i� No SEti'VF�R CONNECTION <br /> S T A T E S U R C H A RGE Yes r/ No �rVATERCONNECTION <br /> �INVESTIGATION FEE Yes � No PARK FEE <br /> SAC Yes No SITEINSPECTTON <br /> Number of SAC�Units OTHER (specify) <br /> ZOLY'1�IG CHE.CK LIST zoaing Discricr. fU� Crh'�-�� , <br /> Fire Department: Post Office; School District: � ' <br /> Lot Area: Sq.ft. Acres � Width Depth <br /> Survey Submitted:� Yes No Date of Survey: <br /> Proposed Setbacks: . : <br /> Froat(Lake): Riaht Side: . <br /> Rear(Street): Left Side: <br /> Adjacent Structures: etland: <br /> Builclin�Hei�.t: Def. Hgt. Peak Hgc. <br /> Lot Coverage: <br /> Grading: Staff Approval Date: B • Council Approval Date: ' <br /> Sepcic: Staff Approval Date: �Y� <br /> Zoain� File: � Resolutioo: # Resolution Date: <br /> Shoreland Dis[rict: <br /> Av;. Setback: Bluff Setback: L.otCovera�e: <br /> E�isting Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Ka:dco�er Variance Req�ired: Yes No D3ce eF Co��il Appr�v21: <br /> �- �E��L.4RI�S (in house): /tk s774/+�S�P� !.J r TN�v� ,P PlL� � T' <br />