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CHECK OFFLIST FOR ISSUANCE OFPERMITS <br /> FOR OFFICE LISE ONLY <br /> ADDRESS OR LEGAL: ,� � � � � � p ..� t,,,�7�# j�� <br /> PID: � <br /> DESCRIPTIONOF WORK: Cu <br /> ZONING REVIEW BY.• DATEAPPROVED: ,S O� <br /> BUILDING REi�IEW BY.• DATEAPPROVED: s-g - o g <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PE��' Yes �/ No <br /> PLAN REVIEW Yes_� No SEWER CONNECTION <br /> STATE SURCHARGE Yes ,/ No WATER CONNECTION <br /> INVESTIGATION FEE Yes No ,/ PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> IVumber of SAC Units pq�� �23�s �o_zq_c� OTHER (specify) <br /> ZONING CHECg LIST Zoning District: (�— � <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres�,� Width Depth <br /> Survey Submitted: Yes � No Date of Survey: �I O /�W -���Od' <br /> Proposed Setbacks: �� �l <br /> Front(Lake): .� -�tigitt Side: <br /> i S � � <br /> Rear(Street): 1 aft Side: <br /> Adjacent Structures: /��- Wetland: {'�� <br /> Building Height: Def.Hgt. _�� Peak Hgt. <br /> Lot Coverage: <br /> �� <br /> r f'-K' ,r <br /> Grading: StaffApproval Date: S-�8^� By: �� Council Approval Date: <br /> Septic: StaffApproval Date: � � gy; (,v� <br /> Zoning File: # ��' Resolution: # Resolution Date: <br /> Shoreland District: v�g MCWD Permit: <br /> Avg. Setback: �/L Bluff Setback: Lot Coverage: <br /> � Progosed <br /> Hardcover: 0-75' (J <br /> 75-250' _��S� ��rJ <br /> 250-500' �1/1 / _ � /�1 <br /> ��.�.�.� � <br /> 500-1000' �, � <br /> Hardcover Yariance Required: Yes No� Date of Council Approval: <br /> REMARKS(in house): <br /> 33 <br />