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CHECK OFF LIST FOR ISSUANCE OF PERII�IITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: '`t l`t 5 FU(Z�.S�- i�v�tc.E ����`.i� <br /> PID: <br /> DESCRIP'I'ION OF WORK: ��C1t <br /> ------------------------------------ -----,----------------------------------------------------------------------- <br /> ZO�1II�tG REVIEW BY: °, ��'< � %'�act--- DATE APPROVED: `� - 1�1��i � <br /> BUILDING REVIEW BY: , v��- DAT'E APPROVED: � - (�i - 5��7 <br /> FEES TO BE CHARGED: ` Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No . <br /> PLAN REVIEW Yes �r' No SEWER CONNECTION <br /> STATE SUR`HARG� Yes r/ No WATER CONNECTION <br /> INVESTIGAZ'ION-FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ----------------------------------------------------------------------------------------------------------------- <br /> ZONING CHECK LIST Zoning District: L/z' �� <br /> Fire Department: r vk%J v�%" Post Office: �vLo., �� School District: ��,� ���.vtic.�E _ <br /> Lot Area: Sq.ft. � 5. ��Z.. Acres 3 b Width i S Z�� ��vE Depth t p.a .�,� <br /> Survey Submitted: Yes� No Date of Survey: � -3 � _ `��-' <br /> Proposed Setbacks: � � <br /> Front (Lake): _ -7( Right Side: �� �= <br /> Rear (Street): �Z � Left Side: 7 D� �= <br /> Adjacent Structures: V�}��N�C)'1 �Vetland: !u i 1'3 <br /> Building Height: Def. Hgt. N(� Peak Hgt. �' <br /> �'(� <br /> Lot Coverage: ��-� <br /> Grading: Staff Approval Date: � 1 � By: `- Council Approval Date: �`— <br /> Septic: Staff Approval Date: ,N ��t BY� — <br /> Zoning File: # Z��2- Resolution: # Resolution Date: �� - Z3 `I G� <br /> Shoreland Dist:ict: N�% . <br /> Avg. Setback: Bluff Setback: I.ot 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 /> . 26 <br />