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CHECK OFF LIST FORISSUANCE <br /> E OF PERMITS <br /> FOR OFFICE USE <br /> ADDRESS OR LEGAL: 12.__6(3k w • L.A Foy c'.TTS PID: <br /> DESCRIPTION OF WORK: GR�4VtN(o <br /> DATE APPROVED: 3•2-1-9 6 <br /> ZONING REVIEW BY: DATE APPROVED: <br /> BLTLDL?G REVIEW BY: <br /> FEES TO BE CHARGED: 6 to <br /> Misc. Fees Calculated By: <br /> PERMIT Yes CONNECTION REVIEW Yes No 1----- SEWER <br /> STATE SURCHARGE Yes No WATER CONNECTIONP FEE <br /> SAC -Yes <br /> INVESTIGATION FEE Yes Noo SITE liNSPECTION <br /> OTHER (specuy) <br /> Number of SAC units <br /> ZONE G CHECK LIST <br /> Zoning District: LA.-/13 Shoreland District: VCE-S <br /> Fire Department: <br /> st Office: School District: <br /> Lot Area: Sq.ft. <br /> Acr sWidth Depth <br /> Survey Submitted: Yes _le_ <br /> No Date of Survey: ew F'w <br /> Proposed Setbacks: Right Side: <br /> Front (Lake): <br /> Rear (Street): Left Side: <br /> Adjacent Structures: <br /> Wetland: <br /> Building Height: Def. Hgt. <br /> Peak Hgt. <br /> Avg. Setback: <br /> Bluff Setback: Lot Coverage: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> t� 250-500' <br /> iti <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> Grading: Staff Approval Date: Bv: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Resolution: # Resolution Date: <br /> Zoning File: #________ ' <br /> RE�I-IARKS (in house): <br /> 26 <br />