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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: �`35�-I f?x si P o i rv z C� 2 c�.�. <br /> PID: <br /> DESCRIPTION OF WORK: ���-�� <br /> --------- ------ — -------- � <br /> ZO�'G REVIEW BY: DATE APPROVED: S - � - 5�! <br /> BUILD�'G REVIEW BY: DATE APPROVED; S- �• -95 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Yes i/ No SEWER CONNECTION <br /> STATE SURCHARGE Yes ✓ No WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZONING CH�CK LIST Zoning District: LQ- I(3 <br /> Fire Department: VVI,��rr� Post Office: W�v n.,/� School Dis[rict: w�e S��v (��1 <br /> Lot Area: Sq.ft. '�1,Ze�J Acres ,"12 Width � �Z 1 Depth <br /> Survey Submitted: Yes d� No Date of Survey: o�r f=�1.�, <br /> Proposed Setbacks: i <br /> Front(Lake): �3 Right Side: ZS� <br /> Rear (Street): I(2 � Left Side: l� � <br /> Adjacent Structures: �4�'�c�l,/ Wetland: — <br /> Building Height: Def. Hgt. /1/ �� Peal:Hgt. — <br /> Lot Coverage: c9��. <br /> Grading: Staff Approval Date: n��/a By: — Council Approval Date: — <br /> Septic: Staff Approval Date: — By: — <br /> Zoning File: # Z'-l�1-� Resolution: # Resolution Date: y-Z� -��l <br /> Shoreland District: P <br /> Avg. Setbac : 0,(,�- Bluff Setback: IvU LotCoverage: <br /> Eusting Proposed <br /> Hardcover: 0-75' ��� y' � <br /> 75-250' `i� `��• 7 <br /> 250-500' I 2.S�B �Z- �g <br /> 500-1000' <br /> Hardcover Variance Required: Yes_Q� No Date of Council Approval: <br /> REMARKS (in house): <br /> 7 <br />