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CHECB OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS ORLEGAL: 2z.2.g �riA�4y woo� 2�ero/, � . <br /> ' PID: <br /> DESCRIPTION OF'WORK: �,U�r,�^1 <br /> ZOrTi 1G REVIEW BY: DATE APPROVED: f3•L6 `�3 <br /> BUII..DI�i IG REVIEW BY: DATE APPROVED: b°•Z6 ��3� � <br /> FEES TO BE C�iARGED: Misc. Fees Calculated By: <br /> PERII�IIT Yes ✓ No <br /> pLAN REVIEW Yes ,/ No SEWF�Z CONNECTI4I�i <br /> STATE SURCHARGE Yes �/ No WATF�tCONNECITON <br /> INVESTIGATION FEE � Yes No �' PARK FEE <br /> SAC Yes No� STTEINSPEC'lTON <br /> Number of SAC�Units OTHER (specify) <br /> ZONiNG CH�CB LIST Zoning District: , <br /> Fire Department: � Post O�ce: School District: • � <br /> Z o"1�(. � <br /> Lot Area: Sq.ft. ��ib Acres .1� � Width Depth <br /> Survey Submitted: Yes � No Date of Survey: 1`3'ZZ'n3 <br /> Proposed Setbacks: � <br /> Front(Lake): �•(� Right Side: L�.�'� <br /> Reaz(Street): °f 2� + I.eft Side: 1!7•7 � <br /> Adjacent Structures: `13� �Vetland: �✓/rt . <br /> Building Hei�ht: Def. Hgt. ,i✓(� Peal:Hgt. <br /> Lot Coverage: /�S� <br /> Grading: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zonin�File: # —" Resolution: # Resolution Date: � <br /> Shoreland District: y 1'S "� <br /> Avg. Setback:� Bluff Setback: � Lot Coverage: //•� <br /> Ezisting '� Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> . 250-500' z�.3 Z 2b.3� <br /> 500-1000' 35, b$ ��. "�� <br /> Hardcover Variance Required: Yes No�_ Date of Council Approval: <br /> REMA,R]KS(in house): �� <br /> � . . . . <br />