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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS ORLEGAL: �3� e r3+�c.���1't �PA�.1c �-o�-O <br /> PID: <br /> DESCRIPTION OF WORK: (Z�.�s.e +(l.�o A,o� L,.s�Nrvo,.,,s <br /> ZO.�i 1G REV�W BY: � _ -----F------ DATE APPROVED: '�- Y �cr3 <br /> BUII..DI�i 1G REVIE`V BY: DATE APPROVED; �/--y -�_ <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes _� No <br /> PLAi�i REVIEW Yes l/ No SEWER CONNEG"TION <br /> STATE SURCHARGE Yes No WATER CONNECITON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTTON <br /> Number of SAC�Units OTHER (specify) <br /> ZONING CH�CK LIST Zoning District: �2� i C. . <br /> Fire Department: Post Office: School District: � <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes�_ No Date of Survey: Z-�l "0-3 <br /> Proposed Setbacks: � <br /> Ffeat(Lake): zs. � � Right Side: 34 ' + <br /> Rear(Street): i 30 ' }- Left Side: ��b � '� <br /> Adjacent Structures: — �Vetland: �' <br /> Building Height: Def. Hgt. Nv c vi.9n•yc Peal:Hgt. -- <br /> Lot Coverage: it!�C. <br /> Grading: Staff Approval Date: N 1 G By: � Council Approval Date: — <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # 0 3-v6�S Resolution: # Resolution Date: 3•��- d 3 <br /> Shoreland District: �S <br /> Avg. Setback: V�4�l1.��qnrt,�= Bluff Setback: �/GA- L.ot Coverage: N��- <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' N•L. <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No_�c Date of Council Approval: <br /> R.ENIARKS (in house): <br /> 7 <br />