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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 3(o C'O -ro q ft e cI <br /> PID: <br /> DESCRIPTION OF WORK: �� l0� k 1 A' eft C k 64c&L PAX S' deet t <br /> Owrs <br /> ZONING REVIEW BY.• 412'J- <br /> DATEAPPROVED: ltd + std M� <br /> BUILDINGREVIE WBY.• DATEAPPROVED: io -g -a(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 v`� No WATER CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No v` SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECKLIST Zoning District: <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted. Yes No Date of Survey: IO <br /> Proposed Setbacks: eps►- /- <br /> Front(Lake): PIA 44&Side: 6 t d e deck) <br /> i <br /> Rear(Street): Left Side: nA <br /> Adjacent Structures: ltif4 Wetland.- <br /> Building <br /> etland:Building Height: Def. Hgt. Ad 1A Peak Hgt. N t A <br /> Lot Coverage: Alo.,xd s y zoo sqvpee,kAa-\ •propos.Lcl =i7 6 06 <br /> Grading: Staff Approval Date: Af j,A By: Council Approval Date: <br /> Septic: Staff Approval Date: iv 1,4 By: <br /> Zoning File: # -- Resolution: # — Resolution Date: <br /> Shoreland District. MCWD Permit: <br /> Avg. Setback: /V(l.�i Bh ff Setback: n(1 A Lot Coverage: _ <br /> Existing Proposed <br /> Hardcover: 0-75' r-- -- <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS(in house): Gr k e%exs g ncA �n!iqa e `�,. <br /> 33 <br />