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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 41.765 CAM i eR OwN /24,40 <br /> PAD: <br /> DESCRIPTION OF WORK: 3 s enev oev Voc1.c..(4 <br /> ZONING REVIEW BY: ,. DATE APPROVED: 7- u -01 <br /> BUILDING REVIEW BY: MEMlei DATE APPROVED: 1•Z-6-cs) <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes t/' No <br /> PLAN REVIEW Yes No SEWER CONNECTION <br /> STATE SURCHARGE Yes No WA LER CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No S1'1'EINSPECTION <br /> Number of SACUnits OTHER (specify) <br /> ZONING CHECK LIST Zoning District: <br /> Fire Department: Post Office: School District: <br /> `G <br /> � Lot Area: Sq.ft. Acres Width Depth <br /> G�A <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: <br /> Front (Lake): 21 2%°' + Right Side: \b 0' i' <br /> Rear (Street): 140' + Left Side: gCD' ± <br /> Adjacent Structures: A-t-mc(¢`� Wetland: N (A <br /> Building Height: Def. Hgt. O NV_ Peak Hgt. <br /> Lot Coverage: /Y.O. . <br /> Grading: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # — Resolution: # Resolution Date: <br /> Shoreland District: Nt2 <br /> Avg. Setback: Bluff Setback: Lot Coverage: <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 /> REMARKS (in house): <br /> 7 <br />