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CHECK OFF LIST FOR ISSUANCE OF PERi'1�IITS <br /> FOR OFFIC� USE ONLY <br /> ADDRESS OR LEGAL: _3.j � 5 (� f"�� �C,��� �` <br /> PID: <br /> DESCRIPTION OF WORK: (.a.�ti.� �,,�J' , <br /> ZOiVPtG REVIEW BY: DATE APPROVED: S-IO •�r�'v' <br /> BUII�DI�i tG REVIEW BY: DATE APPROVED: � �{o �S <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes �/ No � <br /> PLAN REVIEW Yes � No SEWER CONNECTION <br /> STATE SUR�HARG� Yes � No WATER COVNECTION <br /> INVESTIGATION-FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECK LIST zoning District: RR.-1f3 <br /> Fire Department: Post Office: (p�r� (/�.�� School District: pf(�^i� <br /> L.ot Area: Sq.fr. Z`8��1(1.� Acres (�• �'((, 1�Vidth 33f� Depth QS.3.b� <br /> Survey Submitted: Yes 0� No Date of Survey: � •24 .y p,� <br /> Proposed Setbacks: <br /> Front (Lake): Z l0 � Right Side: I 2`{.9 . <br /> Rear(Street): � `� .7. Lefr Side: J�{"�. <br /> i� <br /> � <br /> Adjacent Structures: ( (,0 '�" Wetland: /t,J /J} � <br /> Building Height: Def. Hgt. ?� Peak Hgt. Z.4 � <br /> Lot Coverage: /i�lp- <br /> Grading: Staff Approval Date: '" By: Council Approval Date: <br /> Septic: Staff Approval Date: � By: <br /> � Zoning File: # — Resolution: # ` Resolution Date: <br /> Shoreland Dis�ict: jva <br /> Avg. Setback: Bluff Setback: L.ot Coverage: <br /> � Ezisting 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): <br /> • 26 . <br />