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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 1.3 s v „ ck. a A r-�.2J— <br /> PID: <br /> DESCRIPTION OF WORK: '4(QvlcK' N.-e/1N cc J tiny 1 J 241,C,/ ;c? <br /> ZONING REVIEW BY: Z 47/:1' DATE CV/L6:7�'exist0Hy <br /> Lill <br /> BUILDING REVIEW BY.• �fi�G'f rc�'/ ' <br /> DATE APPROVED: s -12-0q ("("2"` // <br /> 624-.�J''!Lvl/'� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: 0/,/0,5 C.-- <br /> PERMIT Yes ,� No firs)1'/®'� <br /> PLAN REVIEW Yes ,/ No o a ,..v cy. <br /> / <br /> SEWER CONNECTION e <br /> STATE SURCHARGE Yes 17" x sh co o <br /> / �L <br /> INVESTIGATION FEE YeS NO WATER CONNECTION ky pv7 <br /> No__� PARK FEE cv cs <br /> SAC Yes No SITE INSPECTION <br /> Number of SAC Units OTHER (spec) <br /> ZONING CHECK LIST Zoning District: _____V - a <br /> Fire Department: Post Office: <br /> School District: <br /> Lot Area: Sgft. • Acres Width <br /> Depth <br /> Survey Submitted: Yes No of y � <br /> ZG �, <br /> Date Survey: C <br /> Proposed Setbacks: <br /> Front(Lake): . Right Side: <br /> • <br /> • <br /> Rear(Street): Left Side: <br /> Adjacent Structures: Wetland: <br /> Building Height: Def. Hgt. Peak Hgt n C Cl1ons67 .. . <br /> Lot Coverage: --: I`I S y.1S1)n y '' 2 2. 1 7r e p o 1q 7, 'f % <br /> a <br /> n Ct <br /> Grading: StafJApproval Date: i�,/�J <br /> By: Council Approval Date: <br /> Septic: Staff Approval Date: /vA By: (J(I- <br /> Zoning <br /> IZoning File: # Resolution: # Resolution Date: <br /> Shoreland District: <br /> MCWD Permit: <br /> Avg. Setback /2 (4- BlufSetback: <br /> 1•7 a- Lot Coverage: <br /> Existing Proposed <br /> Hardcover: -0-75' <br /> 75 250' ` 7 c} c�irrYti <br /> 250-500' <br /> 500-1000 7 t i 4)co 00 (4.4i,f2 <br /> Y g`c/ 6 %767 Ct i (y.-- <br /> . <br /> Hardcover <br /> t- <br /> Hardcover Variance Required: Yes No ;/ <br /> Date of Council Approval: <br /> REMARKS(in house): <br /> 33 <br />