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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 3 l S l o(Do 0 1-1, tz. <br /> PID: <br /> DESCRIPTION OF WORK: c. Lr , <br /> c <br /> ZONING REVIEW BY: \f U DATE APPROVED: 10 �S9 - cc,%=.BUILDING REVIEW BY: (� DATE APPROVED: l u-i fB-oD <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes V No <br /> PLAN REVIEW Yes v/ No SEWER CONNECTION <br /> STATE SURCHARGE Yes ✓ No WAthRCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No S1"i'.INSPECTION <br /> Number of SAC-Units OTHER (specify) <br /> ZONING CHECK LIST Zoning District: <br /> ApfyFire Department: Post Office: School District: . <br /> 0/(iv- <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes No Date of Survey: o cf (= w <br /> Proposed Setbacks: <br /> Front(Lake): ---,b. 1.-1 Right Side: I IS O -- <br /> Rear (Street): 3 6 t Left Side: y $� <br /> Adjacent Structures: 2.5-t ` Wetland: <br /> Building Height: Def. Hgt. — Peak Hgt. <br /> Lot Coverage: N +/k <br /> Grading: Staff Approval Date: — By: -' Council Approval Date: <br /> Septic: Staff Approval Date: -- By: <br /> Zoning File: # Resolution: # — Resolution Date: <br /> Shoreland District: /-t) <br /> Avg. Setback: Bluff Setback: Lot Coverage: <br /> Existing Proposed <br /> a <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 />