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. � � C�IECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEG : Ls / <br /> Pm: ,A,�tdus Nc�N� <br /> DESCRIP'rION OF WORK: u� C�. /� . /� <br /> --- ---- ----- ---------------------------------------------�^-------- <br /> ZONING REVIEW BY: DATE APPROVED: q � <br /> BUII..DING REVIEW BY: --�- DATE APPROVED: <br /> FEES TO BE CHARGED: / Misc. Fees Calculated By: ,-'- <br /> PERNIIT Yes ✓ No <br /> PLAN REVIEW Yes No ✓ SEWER CONNECTION <br /> STATE SUR�HARGE Yes No� WATER CONNECTION <br /> INVESTIGAZ'ION-FEE Yes No �- PARK FEE <br /> SAC Yes No�- SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECK LIST zoning District: �'�� �'�� <br /> Fire Departmenr. ��Z Post Office: �/�i�'YZ School District: ��Z <br /> Lot Area: Sq.ft. �- Acres �- Width �--- Depth " <br /> Survey Submitted: Yes ✓ No Date of Survey: ��� 24N- /1P1�-f� ' <br /> Proposed Setbacks: <br /> � <br /> Front(Lake): _ � Right Side: <br /> Reaz(Street): Left Side: � ' <br /> Adjacent Structures: �— Wetland: � � <br /> Building Height: Def. Hgt. �"` Peak Hgt. �- <br /> Lot Coverage: � <br /> Grading: Staff Approval Date: " - ! 7 By:�� Council Approval Date: ��"-! � <br /> Septic: Staff Approval Date: �---- By: �— <br /> Zoning File: # 22d2-- Resolution: # 3$�g Resolution Date: � - — ( � <br /> Shoreland DisL ict: ✓ _ <br /> Avg. Setback: �.. Bluff Setback: -- Lot Coverage: — <br /> � Ezisting Proposed <br /> Hazdcover: 0-75' <br /> 75-250' � <br /> 250-500' o'�� _�� <br /> 500-1000' <br /> Hardcover Vaziance Required: Yes� No Date of Council Approval: � / <br /> REMARKS(in house): ---- ----- - <br /> � <br /> ��� w�U� �`1 ��6 g�y'g`� <br />