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' CHECK OFF LIST FOR ISSUANCE OF PERII�IITS <br /> FOR OFFICE USE ONLY � <br /> ADDRESS OR LEGAL: R ZS �f�R�'Cn�W o o D <br /> PID• <br /> DESCRIPTION OF WORK: I�E�c, <br /> . � � <br /> ZOYIl\G REVIEW BY: DATE APPROVED: ?-� 3 -va <br /> BUII�D�tG REVTEW BY: DATEAPPROVED; 7 -�3 '�� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes ✓' No , <br /> pLAN REVIEW Yes � No SEWF�R CONNECTZON <br /> STATE SURCHARGE Yes � No WAT�1t CONNECITON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No STTEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZONL�iG CH�CK LIST Zoning District: LR-�(3 � <br /> Fire Department: � Post Office: School District: �Z,c�� <br /> Lot Area: Sq.ft. YS, ?93��i Acres �.0 5 Width t R/►�vc.4•2. Depth <br /> Survey Submitted: Yes_� No Date of Survey: 7-'7- �o <br /> Proposed Setbacks: � � <br /> Front(Lake): �Y' Right Side: (6$ '� S <br /> Rear(Street): �4.S Left Side: .� � �_ N <br /> Adjacent Structures: �7'lA-Gt-F'�� Wetlaad: �/�" . <br /> Building Heioht: Def. Hgt. — Peak Hgt. � <br /> Lot Coverage: --- d./G <br /> Grading: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Dace: -- By: <br /> Zoning File: # —'� Resolution: # Resolution Date: <br /> Shoreland District: u�5 <br /> Avg. Setback:�` N/a Bluff Setback: N/� L.otCoverage: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' f L `9� !� "?u <br /> 500-1000' <br /> Hardcover Variance Required: Yes No � Date of Council Approval: _ <br /> RENIARKS(in house): <br /> 7 <br />