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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: Z )0 0,L—r— s P o 27t-- <br /> PID: <br /> DESCRIPTION OF WORK: l—=. 60 a 1 1-7 caN <br /> ----------------------------------------------------- <br /> ZONING REVIEW BY: DATE APPROVED: 9 •ci -o0 <br /> BUILDING REVIEW BY: DATE APPROVED: <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 WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECK LIST Zoning District: _(,f1- /(3 <br /> Fire Department: YKN%..)N y3 Post Office: School District: (meg Tbr 4 t44 <br /> Lot Area: Sq.ft. Aro G«,c Acres /&,IeU—,e c, r,�Width Depth <br /> Survey Submitted: Yes < No Date of Survey: OCT & S 7 <br /> Proposed Setbacks: <br /> Front(Lake): t05 , Right Side: �3 <br /> Rear(Street): 01 4. Left Side: <br /> Adjacent Structures: Wetland: N1^ <br /> Building Height: Def. Hgt. Peak Hgt. p, <br /> Lot Coverage: (9.14— <br /> Grading: <br /> 4-Grading: Staff Approval Date: N/eA- By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # r Resolution: # Resolution Date: <br /> Shoreland District: V,!5 <br /> Avg. Setback: Bluff Setback: Lot Coverage: d.k <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' 41 2 Y• tJ <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No�o Date of Council Approval: <br /> REMARKS(in house): <br /> 7 <br />