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r .. <br /> CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: I(o0 w Y R LANA N O274 <br /> PID: <br /> DESCRIPTION OF WORK: ( C <br /> ZONING REVIEW BY: Q�,.4__ DATE APPROVED: S.� - <br /> BUILDING REVIEW BY: � ,_ DATE APPROVED: cc- -S 9' <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 WATER CONNECTION <br /> INVESTIGATION FEE Y,es No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECK LIST Zoning District: Cn - <br /> I J0 t't Fire Department: Post Office: School District: <br /> t Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: <br /> Front (Lake): 250 t Right Side: (o o l <br /> Rear (Street): °I 0 '4- Left Side: 1 a-o <br /> Adjacent Structures: Z0 Wetland: A✓/r4 <br /> Building Height: Def. Hgt. Peak Hgt. <br /> Lot Coverage: <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File: # 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 Date of Council Approval: <br /> REMARKS (in house): <br /> 7 <br />