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� CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: ► 3� �% t���� P U�ti��c �Zn,a-�a <br /> PID: <br /> DESCRIP'TION OF WORK: �i�c�r r7�rv 5 -- �C� s-Gt-ce� �- �-iv c� S7L2�, 5 <br /> -------------------------------------- ;---�,------------------------------------------------:-------------------- <br /> ZONING REVIEW BY: �-- � ' :�__ DATE APPROVED• 2 S -�i� <br /> BUII..DING REVIEW BY: �� ,�;,._ DATE APPROVED: z-S — �`d <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓' No <br /> PLAN REVIEW Yes ✓ No SEWER CONNECTION <br /> STATE SUR`HARGL Yes v� No WATERCONNECITON <br /> INVESTIGA'I'ION FEE Yes No PARK FEE <br /> SAC Y::s No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ----------------------------------------------------------------------------------------------------------------------- <br /> ZONIlVG CHECK LIST zoning nisui�c: L>2-ie.3 <br /> Fire Department: Wl,o�n�✓J Post Office: �'�1,c u iv v-� School District: l,v��7ti;N k:�4 _ <br /> Lot Area: Sq.ft. °�,`t 5 Z Acres ' 2'2 Width � 5 Depth �5 � � <br /> Survey Submitted: Yes � No Date of Survey: t Z� `1(� ' <br /> Proposed Setbacks: <br /> Front (Lake): _ ��1 ��- Right Side: I 3 � <br /> Rear (Street): �j�( � t Left Side: `f 5 ! <br /> Adjacent Structures: r`r7'T}�}G!�'t�� Wetland: !��/a- <br /> Building Height: Def. Hgt. � ' << Peak Hgt. -- <br /> Lot Coverage: �q .� <br /> Grading: Staff Approval Date: N �P� By: -" Council Approval Date: — <br /> Septic: Staff Approval Date: N (� By: <br /> Zoning File; # 2�3 l Resolution: # 63 Resolution Date: 1 l '1,3-S S <br /> Shoreland Distict: <br /> Avg. Setback. c�.I� Bluff Setback: /� (f� L.otCoverage: tq�`t • <br /> � Existing Proposed <br /> Hazdcover: 0-75' ti I •`�o l t• <br /> 75-250' �U. Z S I •5 <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes_� No Date of Council Approval: ( � - � 3 -ti� <br /> REMARKS(in house): <br /> • 26 <br />