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. . � <br /> • CHECK OFF LIST FOR ISSUAriCE OF PERi��LITS <br /> FOR OFFICE USE ONLY <br /> �DDRESS OR LEGAI.: y O �3►'�`l����=- l2 OoqiO <br /> PID: <br /> DESCRIPTION OF WORb: r�0 �Tl o� <br /> ------------- ------_ <br /> ZONING REVIEW BY: _. DATE APPROVED: �!-5 ' � <br /> BLTII.DING REVIE`� BY: DATE APPROVID: �{-�'i.-�vL <br /> - -------------------------- <br /> FEES TO BE CHARGED: Vlisc. Fees Calculated By: <br /> PERMIT Yes cl No <br /> pLAN REVIEW Yes � No SEWER CONivECTION <br /> STATE SURCHARGE Yes � No WATER COi�NECTION <br /> INVESTIGATION FEE Yes No � PARK FEE <br /> SAC Yes No � s� INSPECTION <br /> Number of SAC Units OTHER (specify) �_��_Yrr <br /> ------�---------------------- <br /> ZO�TING CHECK LIST Zoning District: LR-1l4 Shoreland District : YI=S <br /> Fire Department: (,o�_ Post Office: Lo.�'i <br /> Gd� School District: OfZon�D <br /> ( oZ,�i2o Acres 2.35 Width I�� Depth s�� <br /> Lot Area: Sq.ft. k� <br /> Survey Submitted: Yes � No Date of Survey: ��-�4 � �3 <br /> Proposed Setbacks: � �/� <br /> Ffeat ;Lake): /7S Right Side: <br /> R,ear (Street): ��� Left Side: .S 3 � � <br /> Adjacent Struccures: �Tn4�ft� Wetland: N�� <br /> Building Height: Def. Hgt. _�(L _ Peak Hgt. (�� <br /> f,o r -fo c.�15 r �S <br /> Avg. Setback: N�iq <br /> "'°T "` s�°�luff Setback: /✓�� Lot Coverage: ��/Q <br /> Eeisting Proposed <br /> Hardcover: 0-i 5' <br /> 75-250' <br /> 250-SOa' <br /> 500-1040' <br /> Hardcover Variance Reauired: Yes No Da[e of Council Approval: <br /> Grading: Staff Approval Da[e: By: Council Approvai Date: <br /> Septic: Staff Approval Date: N�l4 By� <br /> � �� Resolution: � — Resolution Date: ^ <br /> Zoning File: #__ <br /> gEMARKS (in house): <br />