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• ' � K <br /> • t <br /> CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: ��� ;�; ;t ��a ,t���w v�;�•� i2..�,.� <br /> PID: <br /> DESCRIPTION OF WORK: l;a2ti��n�i: c, x,�v�tis, ���� <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING REVIEW BY: � . � � ' ,,�� DATE APPROVED: o i -�; -�� <br /> BUILDING REVIEW BY: �;�n DATE APPROVED: N; � <br /> ---------------------------------------------------------------------------- - -------------------------------- <br /> FEES TO BE CHARGED: �Mi c`��ees C�al ulat d�y `'`J � ��v � ✓ � <br /> PERMIT Yes ,/ No <br /> PLAN REVIEW Yes No ;� SEWER CONNECTION <br /> STATE SURCHARGE Yes _�� No WATER CONNECT'ION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING CHECK LIST Zoning Districr. L/L-�i� <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. 'l l ZZ � Acres . 1 b Width ����.E�is�-�'L Depth <br /> Survey Submitted: Yes J� No Date of Survey: Z zZ- ��% <br /> Proposed Setbacks: <br /> Front (Lake): Right Side: �_ <br /> sr <br /> i-Vl.O�v� t=i� 1-E��✓t/fi'�'a' <br /> Rear (Street): Left Side: <br /> Adjacent Structures: — Wetland: ` <br /> Building Height: Def. Hgt. — Peal:Hgt. <br /> Lot Coverage: �' <br /> Grading: Staff Approval Date: %� � �' ���E By: �- Council Approval Date: J�% ?� c � <br /> Septic: Staff Approval Date: °— By: <br /> Zoning File: # '� S'1 i Resolution: # �lS`-� �, Resolution Date: � <br /> Shoreland District: <br /> A��. Setback: Bluff Setback: Lot Coverage: <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): �'l�c=�v-s �i�,v �� � <br /> 7 <br />