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Ci�CK OFF LIST �'OR iSSUANCE flF �'ERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 3S5 6Tv 3(3S (3AY cZoA.O <br /> ` PID: <br /> DESCRIPTION OF WORK: �qoio�-1 o�s�i�=w�-.�oe�- <br /> ZO�.VIvi G REV�W BY: DATE APPROVED: z-i o• ob <br /> BUII..DING REV�W BY: DATE APPROVED; z.•�o .o,� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes _� No <br /> PLAN REVIEW � Yes �/' No SEWER CONNECTION <br /> STATE SURCHARGE Yes � No WATERCONNECTTON <br /> INVESTIGATION FEE Yes No � PARK FEE <br /> SAC Yes � No v' SIT"EINSPECTION <br /> Number of SAC�Units ��,�.n,,� OTHER (specify) <br /> ZOt�TING CH�CK LIST Zoning Districr. <br /> Fire Department: Post Office: School District: � <br /> Lot Area: Sq.ft. y 3�.b 0� Acres (a Width Dep[h <br /> Survey Submitted: Yes_� No Date of Survey: <br /> Proposed Setbacks: <br /> Front(Lake): 275 Right Side: l {•��•5 <br /> Rear(Street): l"2b•3 Left Side: Sz0 <br /> Adjacent Structures: �j 3 Wetland: t e o <br /> Building Heiahr. Def. Hgt. O • 1� Peal:Hgt. — <br /> Lot Coverave: /�r ��A <br /> Grading: Staff Approval Date: � By: Council Approval Date: � <br /> Septic: Staff Approval Date: c9�. BY� a� •v, wo t�uG�.��s� ,�v /�• 2dey.�•s <br /> Zoning File: # — Resolution: # Resolution Date: <br /> Shoreland District: ND <br /> Avg. Setback: Bluff Setback: L.ot Coverage: <br /> Eusting Proposed <br /> Hazdcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Vaziance Required: Yes No Date of Council Approval: <br /> REMARKS (in house): <br /> 7 <br />