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' CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESSORLEGAL: Zg �S SOMERS�T c..tu.►c <br /> PID: <br /> DESCRIPTION OF WORK: /v e�w 2Es. <br /> Z0�1ING REVIEW BY: o�' C'.�.-- -�N- DATE APPROVED: �o-a g o 2 <br /> BUILDING REV�W BY: DATE APPROVED; i o •z�•�z _ <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes _� No <br /> PLAN REVIEW Yes ✓ No SEWER CONNECTTON <br /> STATE SURCHARGE Yes ✓ No WATERCONNECTION <br /> INVESTIGATION FEE Yes No ✓' PARK FEE <br /> SAC Yes No�_ SITEINSPECTION <br /> Number of SAC�Units s.e.,pT� �r�,�� OTHER (specify) <br /> ZOi�TI�1G CH�CK LIST Zoning District: . <br /> Fire Department: Post OfFice: School District: � <br /> Lot Area: Sq.ft. I ti J.��S3 Acres 3.Z3y�$ Width 3'ig.�2 AVt% Depth 3$I.8'{ R�� <br /> Survey Submitted: Yes � No Date of Survey: 10• �•�Z <br /> Proposed Setbacks: <br /> Front(Lake): °t b• Z.b�'t Right Side: !20� t <br /> Rear(Sueet): ZZo' � Left Side: 1 Sb� '' <br /> Adjacent Structures: �/q Wetland: Sq' <br /> Building Height: Def. Hgt. 2�' Peak Hgt. a3� <br /> Lot Coverage: N//a <br /> Grading: Staff Approval Date: /0 •2� - �2 By: � Council Approval Date: /✓/A <br /> Septic: Staff Approval Date: I�- 2q- n 2 By: r+n.l�. <br /> Zoning File: # — Resolution: # — Resolution Date: — <br /> Shoreland District: N 0 <br /> Avg. Setback: Bluff Setback: LotCoverage: <br /> Eusting Proposed <br /> Hazdcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hudcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS(in house): <br /> 7 <br />