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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: I�jS3S QA�t R�K�C,I': �A� <br /> PID: <br /> DESCRIPTION OF WORK: dccJ� <br /> ZO�IG REVIE`V BY: DATE APPROVED: 9 • �a-oY <br /> BUII.,DI'i�1G REV�`Y BY: DATE APPROVED; � - u�- �`f <br /> FEES TO BE CHARGED: / Misc. Fees Calculated By: <br /> PERiV1IT Yes �/ No <br /> PLAi'V REVIEW Yes �/ No SEWER CONIVECTION <br /> STATE SURCHARGE Yes �� No WATERCONNECTTON <br /> TNVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> -------------------------------------------- <br /> ZONI�tG CHE.CK LIST Zoning District: �-� ' �� <br /> Fire Department: Post Office: School District: � <br /> Lot Area: Sq.ft. 33,$�� Acres ,�6 Widch I/'L '�'"��`� � Dep[h <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: <br /> F'•�e�t(Lake): /3`1•Z- Right Side: ,3f3' � <br /> F�e�ar (Street): 2�S� ' Left Side: 35� t <br /> Adjacent Structures: f�'��� �Vetland: ' <br /> Building Hei;ht: Def. Hgt. -- Pea�:Hgt. "— <br /> Lot Coverage: O.k— <br /> Grading: Staff Approval Date: � By: Council Approval Date: <br /> Septic: Staff Approval Date: � BY� <br /> Zoning File: # D�-/-3a y3 Resolution: /# Resolutioa Date: <br /> Shoreland Dis[rict: y�s <br /> Avg. Setback uq.ru�� Bluff Setback: �//�- L.ot Coverage: �•�< <br /> Ezistino Proposed <br /> Hardcover: 0-75' <br /> 75-250' Z�� �'�•��o <br /> 250-SQO' <br /> 500-1000' <br /> Hazdcover Variance Required: Yes o� No Da[e of Council Approval: <br /> REMARKS (in house): <br /> � <br />