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. 4 <br /> CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 2 35 b lu-1. W i4y7�4 Tyl (31..xl 10 <br /> PID: <br /> DESCRIPTION OF WORK: Roo F C.c.N N e c...7-7 a <br /> ZONING REVIEW BY: DATE APPROVED: /0 .3- o3 <br /> BUILDING REVIEW BY: ✓L -- DATE APPROVED: 1 0- 3. 03 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Yes c/ No SEWER CONNECTION <br /> STATE SURCHARGE Yes I/ No WATER CONNECTION <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: No c ti 4,1 ,4.wo v_ IC <br /> Fire Department: Post Office: .chool District: <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes___V____ No Date of 'urvey: o N t <br /> Proposed Setbacks: <br /> Front (Lake): Right Side: <br /> Rear (Street): Left Side: <br /> Adjacent Structures: Wetland: <br /> Building Height: Def. Hgt. Peak Hgt. <br /> Lot Coverage: <br /> Grading: Staff Approval Date: By: •ouncil Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File: # o3.29`1( Resolution: # Resolution Date: . <br /> Shoreland District: <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 Dat- of Council Approval: <br /> REMARKS (in house): 2.e-3o s si 6,.,P9 • <br /> 7 <br />