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. <br /> CHECK OFF LIST FOR ISSUANCE OF PERNIITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: Z I o y S v b�R w��✓�S . <br /> PID: <br /> DESCRIPTION OF WORB: N E t�,.S (2.�—S <br /> ZONING REVIEW BY: DATE APPROVID: -�j - 22 @r�i <br /> BUIIrDING REVIEW BY• DATE APPROVED: 4- z z-q 4 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> pEgMIT Yes � No <br /> pI,AN REVIEW Yes v No SEWER COrfNEC1�ON <br /> STATE SURCHARGE Yes ,� No WATER CONNECrION <br /> IlWESTIGATION FEE Yes No ✓' PARK FEE <br /> SAC Yes � No SITEINSPECTION <br /> Number of SAC Units �_ OTHER (specify) <br /> ZONING CHECK LIST Zoning District: R-i f� <br /> Fire Department: (,o�rG (Ai� Post Office: ��6 ��� School District: 02ONJ <br /> Lot Area: Sq.ft. �l�b,"ZS ci Acres �• 1 Width f�v�•4/t Depth <br /> Survey Submitted: Yes X No Date of Survey: �''� �`� <br /> Proposed Setbacks: <br /> Front(Lake): 5f�•S Right Side: ��•� <br /> Rear(Street): 1 3 5 � � Left Side: �-(Z.� �= <br /> Adjacent Structures: /1/ //�' Wefland: ��� <br /> Building Height: Def. Hgt. Z� Peak Hgt. 3� '� <br /> Lot Coverage: � �K <br /> Grading: Staff Approval Date: 5- Zz • 9 g By: � Council Approval Date: — <br /> Septic: Staff Approval Date: /�//g" BY� <br /> Zoning File: !� — Resolution: # � Resolution Date: -- <br /> Shoreland District: /�1(7 <br /> Avg. Setback: Bluff Setback: Lot Coverage: <br /> Ezisting Proposed <br /> Hazdcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hazdcover Variance Required: Yes No Date of Council Approval: <br /> REMARI�S(in house): <br /> 27 <br />