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` CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 13(0 6 1Z�-�- Po�.,�r f Lo� <br /> PID: <br /> DESCRIPTION OF WORK: A�Ai nv�v <br /> ZONING REVIEW BY: DATE APPROVED: a- Y- /�- a� <br /> BUII.DING REVIEW BY: DATE APPROVED: Y-I 7 - c� <br /> FEES TO BE CHARGED: Misc. Fees Calciilated By: <br /> PERMIT Yes ✓� No <br /> PLAN REVIEW Yes ✓� No SEWER CONNECTION <br /> STATE SURCHARGE Yes � No WATERCONNEC'TION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECK LIST Zoning District: G r1 - l� <br /> Fire Department: ���rv✓� Post Office: r�,s�,,.,,n School District: �,e S���c,,�t <br /> Lot Area: Sq.ft. Z�,p4 3 Acres • (� Z- Width // �� Depth 23S•s4 /��,t <br /> Survey Submitted: Yes oC No Date of Survey: 2 -�L ' �� <br /> Proposed Setbacks: <br /> Front(Lake): I 1 '� � Right Side: Za � = <br /> Rear(Street): (0 g� Left Side: y 2•7� �= <br /> Adjacent Structures: i)T7�RG#(�Y> Wetland: /v//1 <br /> Building Height: Def. Hgt. b��L Peak Hgt. O./� <br /> Lot Coverage: � � • (, <br /> Grading: Staff Approval Date: ---" By: Council Approvat Date: <br /> Septic: Staff Approval Date: — - By: <br /> Zoning File: # zSb� Resolution: /# y�/31 Resolution Date: �'/v' v`� <br /> Shoreland District: y.PS <br /> Avg. Setback: v.!� Bluff Setback: /J`�- Lot Coverage: !�• l. <br /> Existing Proposed <br /> Hazdcover: 0-75' <br /> 75-250' Z�i• 3 3 <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes ot No Date of Council Approval: `'�����-�`'' <br /> REMARKS(in house): <br /> 7 <br />