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' CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 3 5�-1 Z s F+o/L��r n�= 4 2 <br /> PID: o••,a`. <br /> DESCRIPTION OF WORK: 5 f 6 rv s c��/ ��c �sT r�� �o s�' -- <br /> ZO�TING REV�W BY: o -- - ---------- DATE APPROVED: S -(, - S 4 <br /> BUILDING REVIEW BY: DATE APPROVED: <br /> �_____________ _---___---- <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> pLAN REVIEW Yes v- No SEWER CONNECTION <br /> STATE SURCHARGE Yes � No WATER CONNECTTON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No STTEINSPECTION <br /> Number of SAC-Units OTHER (specify) <br /> ZONING CHE.CK LIST zoning Districc: N� G FH4,�.Q <br /> Fire Department: Post O�ce: School District: � <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes No Date of Survey: �� s. s� 1 <br /> C ut STc�sS aiv �-'�6 _ <br /> Proposed Setbacks: �t r� p a 9T 5 � ,� <br /> Front(Lake): Right Si e: �� �� <br /> 2@ Z`1 = <br /> Reaz(Street): Left Sid : _ 3 2 <br /> /�-o/�� n c9sv 2@ I 6 �- n� <br /> Adjacent Structures: Wetland: � 2�.S S� t� <br /> Building Height: Def. Hgt. Peak Hgt. ( �� � 0} 1✓��T� <br /> 1 S� ��'�T �c�.o�� <br /> Lot Coverage: ..@�_ � 'Zy �S O .IC <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File: # Resolution: # Resolution Date: <br /> Shoreland District: <br /> Avg. Setback: Bluff Se ack: Lot Coverage: <br /> Existing Proposed <br /> Hazdcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hudcover Vaziance Required: Yes No Date of Council Approval: <br /> REMARKS(in house): <br /> 7 <br />