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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> { FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: '17 O (Al,l/o(..J Ur&X.-) <br /> PID: <br /> DESCRIPTION OF WORK: N FGA/ ,'2 . <br /> ZONING REVIEW BY: Cy,� DATE APPROVED: /25 Z <br /> BUILDING REVIEW BY: / L (G ,,.,- DATE APPROVED: , 2- •o Z. . <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Yes ✓ No SEWER CONNECTION <br /> STATE SURCHARGE Yes ,/ 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: <br /> Fire Department: Post Office: School District: • <br /> Lot Area: Sq.ft. Acres 1.a S Width Depth <br /> Survey Submitted: Yes pL No Date of Survey: r Z•.3-0 Z <br /> Proposed Setbacks: <br /> Front(Lake): L� Right Side: 41 <br /> Rear(Street): LZ' 1 Left Side: 3(•3x1 <br /> Adjacent Structures: Al/A Wetland: 06. <br /> Building Height: Def. Hgt. 3O Peak Hgt. 37. S <br /> Lot Coverage: dt/ <br /> Grading: Staff Approval Date: 1 2-- c+ • o z By: p,.90 , Council Approval Date: <br /> Septic: Staff Approval Date: N/.# By: — <br /> Zoning File: # — Resolution: # — Resolution Date: — <br /> Shoreland District: ^Jo <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 />