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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: I''�1(0 S H l�t�l,1�t� 02�V c_.� <br /> PID: <br /> DESCRIPTION OF WORK: ►U��s (7x� � <br /> ---------------�----- --------------------------------------�------------- - <br /> ZONING REVIEW BY: � �w�-- DATE APPROVED• l/-z1-�7 <br /> BUILDING REVIEW BY: DATE APPROVED: J t-2�-S 7 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> pERNIIT Yes ✓ No <br /> pLAN REVIEW Yes ✓ No SEWER COrfNECTTON <br /> STATE SUR��iARGE Yes ✓ No WATERCOrfNECTTON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Y::s No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECK LIST Zoning District: L�t-/�9 <br /> Fire Department: ���, (�Il.� Post Office: (,�I/��/?iq-°f'Y�i School District: pRoN O <br /> Lot Area: Sq.ft. /Vb C//��=Acres Width � Depth — <br /> Survey Submitted: Yes c No Date of Survey: �f-�'Z'g�7 <br /> Proposed Setbacks: � <br /> Fror�t (Lake): _ �O� Right Side: 30 0 � <br /> �ear(Street): �123� �' Left Side: N�� <br /> Adjacent Structures: 12� t Wetland: /J�i9 <br /> Building Height: Def. Hgt. O� ��- Peak Hgt. t�� I� <br /> Lot Coverage: N�/¢ <br /> Grading: Staff Approval Date: //- Z�- g� By: � Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File; # — Resoiution: # �-- Resolution Date: '–' <br /> Shoreland Dis�-ict: �5 <br /> Avg. SetbacT �. � Bluff Setback: /�!/�°' LotCoverage: ^/�/a- <br /> • ��g Proposed <br /> Hardcover: 0-75' / o � <br /> 75-250' i Y•'=1S /`(�Y S <br /> 250-500' s.� S 1 <br /> 500-1000' <br /> Hazdcover Variance Required: Yes No_� Date of Council Approval: <br /> REMARKS(in house): _ <br /> 26 <br />