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_ CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ' ADDRFSS OR LEGAL: Z20 �Tv/.�S �3Ay ��J <br /> PID• <br /> DESCRIPTION OF WORK: ��—�- �'�,q,r�.g.�� <br /> ZO.�TI�i IG REVIEW BY: _�_____ DATE APPROVED: 5'- Ls. 0 3 <br /> BUII.DNG REVIEW BY: DATE APPROVED: g- �S -.►� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes r� No <br /> PLAN REVIEW Yes _� No SEWER CONNECTION <br /> STATE SURCHARGE Yes ,/ No WAT'at CONNECTION <br /> IIWESTIGATION FEE � Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZONING CHE.CK LIST Zoning District: . <br /> Fire Department: Post Office: School District: � <br /> I.ot Area: Sq.ft. Acres � Width Depth <br /> Survey Submitted: Yes ✓ No Date of Survey: IO'�� <br /> Proposed Setbacks: � � <br /> i ,,,�2 .� <br /> Front(Lake): !`tO Right Side: <br /> Reaz(Street): Y S� 2 Left Side: I ?v� � <br /> Adjacent Structures: ZI � Wetland: nl 1� <br /> Building Height: Def. Hgt. _ v.{� Peal:Hgt. <br /> Lot Coveraae: nf�/4- <br /> Grading: Staff Approval Date: .r— By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # — Resolution: # Resolution Date: <br /> Shoreland District: f�0 <br /> Avg. Setback: Bluff Setback: Lot 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 /> 7 <br />