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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: _ /t YS s�x n-� AvE ivn • <br /> PID: <br /> DESCRIPTION OF WORK: �(/Ct�! iZ�S- <br /> ZO.vIYi G REV�+W BY: DATE APPROVED: 7-b-o��- <br /> BUII�DING REv�W BY: DATE APPROVED; -�_�_0 5 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW � Yes � No SEWF1t CONNECTION <br /> STATE SURCHARGE Yes —� No WATERCONNECTTON <br /> INVESTIGATION FEE Yes No �/ PARK FEE <br /> SAC Yes � � No,�� SITEINSPECTION <br /> Number of SAC�Units � � OTHER (specify) <br /> ZO�TING CH�CK LIST Zoning District: GR- IA <br /> Fire Department: Post O�ce: School District: <br /> iS9, o0 <br /> LotArea: Sq.ft. � Acres :�S' Width ���F4� Depth <br /> Survey Submitted: Yes_� No Date of Survey: "�-I'�1•03 <br /> Proposed Setbacks: <br /> F�eet(Lake): t 76' � Right Side: y 2.L 8 <br /> Rear(Street): �-{no` '�' Left Side: i s 5 . I <br /> Adjacent Structures: N/✓a Wetland: — <br /> Building Height: Def. Hgt. Z8' Peak Hgt. 3y•'�S <br /> Lot Coveraae: N I!-1 <br /> Grading: Staff Approval Date: � By: Council Approval Date: <br /> Septic: Staff Approval Date: N//� By: " <br /> Zoning File: # 3 d Resolution: /# Resolution Date: �I• ZS•o� <br /> Shoreland District: v�PS <br /> Avg. Setback: Zoe' t Bluff Setback: �ARa� LotCoverage: /�IJA <br /> Ezisting Ds�k �y'G�R. t' Proposed <br /> , Hardcover: 0-75' o v <br /> 75-250' 4 y <br /> 250-500' Z�.7 <br /> 500-1000' <br /> Hazdcover Vaziance Required: Yes No ,( Date of Council Approval: <br /> REMARKS(in house): <br /> 7 <br />