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CHECK OFF LIST FOR ISSUAi�tCE OF PERNIITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: y�O Su55�>c �� <br /> PID: <br /> DESCR�t'ION OF WORK: �v c w r��.S <br /> ZO�i'G REVIEW BY: DATE APPROVED: � -'7- O� <br /> BUII,DING REVIEtiV BY: DATE APPROVED: 43 -�-o� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes ,/' No �� <br /> PLAN REVIEW Yes _� No SEWER CONNECI'ION <br /> STATE SURCHARGE Yes � No WATERCONNEC"ITON <br /> INVESTIGATION FEE Yes No ,/' PARK FEE <br /> SAC Yes No _1� SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZO�G CH�CK LIST Zoning District: R R.-16 <br /> Fire Department: t �A Ic.� Post O�ce: N (h/Cx School District: Q�ZO N t� <br /> Lot Area: Sq.ft. Acres Z t Width t R'2�-�v�2 Depth <br /> Survey Submitted: Yes_ �[- No Date of Survey: (o-Z°t'�� <br /> Proposed Setbacks: <br /> Front(�akeJ: 26�� fi S� Right Side: 3S,7 � <br /> Rear(&t�eet): S�•`1 ' !:- Left Side: �(7� �' <br /> � � <br /> Adjacent Structures: /�f �f{ Wetland: �y� -- <br /> Building Height: Def. Hgt. Z.� Peal:Hgt. 3� <br /> Lot Covera�e: /� �� <br /> Gradino: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: �-'� -0 0 By: �v- <br /> Zoning File: # `— Resolution: !# � Resolution Date: v <br /> Shoreland District: MO <br /> Avg. Setback: Bluff Setback: Lot Covera�e: <br /> Existing 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 /> REI�IARKS (in house): �. f 3�:�(1,�c�� � r� (it�•,.l� (�.��-v�— <br /> � n c tv ,1� S" � �si'J/�0 w—� r � P���'o� 5-�nc� <br /> v <br /> S�fS��'r. <br /> 7 <br />