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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: t z w <-kOt-ki 0-4 r <br /> PID: <br /> DESCRIPTION OF WORK: - ,,e.9 5rt.Al oro , -,-,o" 9 ( k.s ,/t ek._ <br /> ZONING REVIEW BY: J,S0 DATE APPROVED: 5_g-6 2, <br /> BUILDING REVIEW BY: DATE APPROVED: c-9-o Z <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes v-, No <br /> PLAN REVIEW Yes t- No SEWER CONNECTION <br /> STATE SURCHARGE Yes No WATER CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No v SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECK LIST Zoning District: <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes pC No Date of Survey: (4- 2 - C 2. <br /> Proposed Setbacks: <br /> Front(Lake): t 90. v2, ± Right Side: I 0 <br /> Rear(Street): (,2• Co Left Side: <br /> Adjacent Structures: /}-,-7-74 c44e-d Wetland: ov(4 <br /> Building Height: Def. Hgt. 0,K Peak Hgt. <br /> Lot Coverage: 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: V e5 <br /> Avg. Setback: O.k. Bluff Setback: C (/I Lot Coverage: o t/C <br /> Existing Proposed <br /> Hardcover: 0-75' o <br /> 75-250' 9-`-) II •` <br /> 250-500' to-5- <br /> 500-1000' 5500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS (in house): <br /> 7 <br />