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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: Z oci we 313 C2 t9 <br /> PID: <br /> DESCRIPTION OF WORK: q d p t-n toa / ( ✓i-t of <br /> ZONING REVIEW BY:: e- i- - L•v • DATE APPROVED: 1-t 5-v�� <br /> BUILDING REVIEW BY: 014 ��,,,,a,_- DATE APPROVED: - ,s Na e <br /> FEES TO BE CHARGED: '' Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Yes 4/ No SEWER CONNECTION <br /> STATE SURCHARGE Yes ,/ No WATER CONNECTION <br /> INVESTIGATION FEE Yes No ,/ PARK FEE <br /> SAC Yes No SITE INSPECTION <br /> Number of SAC Units OTHER (spec) <br /> ZONING CHECK LIST Zoning District:Fire Department:Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes )( No Date of Survey: '7-t -0 a <br /> Proposed Setbacks: <br /> Front(Lake): 8 i'!' Right Side: 61• <br /> Rear(Street): /011 -I- Left Side: 134' 4:- <br /> Adjacent <br /> Adjacent Structures: /4TT14G14-t,, Wetland: Al/ <br /> Building Height: Def. Hgt. 0,k Peak Hgt. — <br /> Lot Coverage: 0.K <br /> Grading: Staff Approval Date: ^rIi By: Council Approval Date: <br /> Septic: StaffApproval Date: 7-¢ c-vhf By: w.6_ 41 <br /> Zoning File: # Resolution: # Resolution Date: <br /> Shoreland District: dolt WW1)Permit: <br /> Avg. Setback: Iv t/-y Bluff Setback: A//A Lot Coverage: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' 0•1< <br /> 500-1000' <br /> Hardcover Variance Required: Yes No pe- Date of Council Approval: <br /> REMARKS(in house): <br /> 33 <br />