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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESSOR LEGAL: 3b r�o -c oG o 20 p <br /> PID: <br /> DESCRIPTION OF WORK: iQ cZ(rL <br /> ZONING REVIEW BY: DATEAPPROVED: s-2-3- o� <br /> BUILDING REVIEW BY: DATE APPROVED: 5--z 3 • #,3 <br /> S4- fla <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 WATER CONNEC HON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SI TEINSPECTION <br /> Number of SAC-Units OTHER (specify) <br /> ZONING CHECK LIST Zoning District: <br /> Fire Department: - Post Office: School District: <br /> Lot Area: Sq.ft. Z I,4 f61.b Acres y q Width Depth <br /> Survey Submitted: Yes_ c� No Date of Survey: 13 z <br /> Proposed Setbacks: <br /> Front(Lake): S� "F Right Side: 3 5'+ sT. s.oz. <br /> Rear(Street): — Left Side: tv) f <br /> Adjacent Structures: i u' Wetland: N(#4 <br /> Building Height: Def. Hgt. /jto- Peak Hgt. — <br /> Lot Coverage: <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # Resolution: # Resolution Date: <br /> Shoreland District: V <br /> Avg. Setback! ny i/I Bluff Setback: — Lot Coverage: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <30 W;6 <br /> 500-1000' <br /> Hardcover Variance Required: Yes No_K Date of Council Approval: <br /> REMARKS(in house): <br /> 7 <br />