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CHECK OFF LI O <br /> T FOR ISSUANCE OF PERMITS <br /> S <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 5 z.o -ro IVl�4w d� <br /> PID: <br /> DESCRIPTION OF WORK: (20#,k 1J,-(,c:E; <br /> ZONING REVIEW BY: DATE APPROVED: q -2 -c� <br /> BUILDING REVIEW BY:4A DATE APPROVED: q • Z,-7 <br /> ---------------------- ------------------------------------------------------------ <br /> FEES TO BE CHARGED: Misc. Fees Calculated B <br /> PERMIT Yes No <br /> PLAN REVIEW Yes ,/� No SEWER CONNECTION <br /> STATE SURCHARGE Yes ✓ No WATERCONNECITON <br /> INVESTIGATION FEE Yes No _� PARK FEE <br /> SAC Yes No ✓ SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ---_______----------------------------------------------------------- ----—-------------------------------------- <br /> ZONING <br /> _ _ZONING CHECK LIST Zoning District: <br /> Fire Department: (A Post Office: GH•w School District: cs ttr/ -0 <br /> Lot Area: Sq.ft. N'o a:J,6 +Acres Width Depth <br /> Survey Submitted: Yes 0-,_ No Date of Survey: 25 Z.q 0 O <br /> Proposed Setbacks: + <br /> Front(L^ake): ISI, Right Side: 3 00 <br /> Rear(Street): 3 o Left Side: 3 a'D <br /> Adjacent Structures: ty l Wetland: IS t <br /> Building Height: Def. Hgt. 0. 1c. Peak Hgt. o,lc <br /> Lot Coverage: nl 1A <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•l.S <br /> Avg. Setback: /,0 f 2- Bluff Setback: Lot Coverage: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' U_Jc, <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS(in house): <br /> I <br /> 7 <br />