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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: Z3"35 �s�-�r�d��._:vc�:� �� <br /> PID: <br /> DESCRIPTION OF WORK: /�;��; i2�.� <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING REVIEW BY: r,. ��vd,�-_ DATE APPROVED: q -i 3 �� <br /> BUILDING REVIEW BY: �. � ,,.� DATE APPROVED: � -� 3 `�S- <br /> -----------------------------------------------� --------------------------------------------------------------------- <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Yes � No SEWER CONNECTION <br /> STATE SUR:I�ARG� Yes c/ No WATER CONNECTTON <br /> INVESTIGA'I'ION-FEE Yes No �� PARK FEE <br /> SAC Yes No �� SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING CHECK LIST Zoning District: ('ti�' ��j <br /> Fire Department: (�.;;v , ��-�r..�� Post Office: ��;�;, l/L�G�- School District: _� f�..C,t�r._; <br /> Lot Area: Sq.ft. Z Acnk� '�= Acres '— Width �Y�.��.(�u.;�..� Depth — <br /> Survey Submitted: Yes r:. No Date of Survey: �-t 5���(�. <br /> Proposed Setbacks: <br /> Front (Lake): �u•� Right Side: �1,' l�� <br /> Rear (Street): �b� ' } Left Side: 3�%� � <br /> Adjacent Structures: /" (ff� Wetland: N t r4 _ <br /> Building Height: Def. Hgt. 'Z�� Peak Hgt. :�L <br /> Lot Coverage: �; r�- <br /> Grading: Staff Approval Date: �'f -r 3 ' `l � By: -(1, ouncil Approval Date: /L's'j'� <br /> Septic: Staff Approval Date: ��/ �� By: . <br /> Zoning File: # ^ Resolution: # -- Resolution Date: — <br /> Shoreland Dist:ict: ��`� <br /> Avg. Setback: t�i�f� Bluff Setback: .�' t� Lot Coverage: o��/'/� <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' �. �� <br /> 250-500' . <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS (in house): <br /> � 26 <br />