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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 5 o ()kJ c_Gt)w ( � <br /> PID: <br /> DESCRIPTION OF WORK: NE-0,3 <br /> ZONING REVIEW BY: �P`, I _ DATE APPROVED: 2-- -i-v t <br /> BUILDING REVIEW BY: , Qo (i >�,�,`- DATE APPROVED: -f1 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes t/ No <br /> PLAN REVIEW Yes v No SEWER CONNECTION <br /> STATE SURCHARGE Yes No WATER CONNECTION <br /> INVESTIGATION FEE Yes No c' PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC-Units OTHER (specify) <br /> ZONING CFMCK LIST zoning District: R C2- - 1G <br /> Fire Department: (-4)/%4C, (A(Lt: Post Office: Ge&G G4-M5- School District: 6/146/0-0 <br /> Lot Area: Sq.ft. 513,(BO' Acres I.3S Width i 2fZ o c/�/L Depth — <br /> Survey Submitted: Yes ,i_ No Date of Survey: /-3O -01 <br /> Proposed Setbacks: <br /> Front(Lake): q 51 Right Side: Li 9 <br /> Rear (&Meet): 143(,1 Left Side: 3`9' C,J <br /> Adjacent Structures: NJ 1/'r Wetland: "✓/ 4 • <br /> Building Height: Def. Hgt. 2° Peak Hgt. z� S <br /> Lot Coverage: b << <br /> Grading: Staff Approval Date: 2- - p( By: 0/A - Council Approval Date: <br /> Septic: Staff Approval Date: al("A 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 />