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� CHECK OFF LIST FOR ISSUANCE OF PERI�IITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 3��� QA�I s�� � �>��4�� <br /> PID: <br /> DESCRIP'TION OF WORK: t�.r�r.� � ��,�; ���WLG UCZ <br /> -�-----�---------------------------�--------------------------------------------------------------------------------- <br /> Z0�1G REVIEW BY: �: ��,.u,� DATE APPROVED: y- � y 7 <br /> BUILDING REVIEW BY: ' - (Si.;� DATE APPROVED: � - � `=7 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERiti'�T Yes ✓� No <br /> PLAi REVIEW Yes ✓' No SEWER CONNECTION <br /> ST�� � SUR�HARGE Yes ,/ No WATER CONNECITON <br /> I�+�` :�IGATION-FEE Yes No PARK FEE <br /> Sr� Yes No SITEINSPECTION <br /> r �.mber of SAC Units OTHER (specify) <br /> ----- .----------------------------------------------------------------------------------------------------------------- <br /> Z�' `='� CHECK LIS�' Zoning District: L('�-!f� <br /> Fire Department: ny �AK-t! Post Office: ��y Cs�-�w School District: L>2.�n�o <br /> � <br /> Lot Area: Sq.ft. Zc�, �y 3 •32_-- Acres •y(, Wid[h �R(Z,�;6vc�/��� Depth <br /> Survey Submitted: Yes X No Date of Survey: �c�-Z'-{ -�t lo <br /> Proposed Setbacks: <br /> Front (Lake): n�/� Right Side: 3.� � <br /> Rear (Street): �{S� Left Side: 15' <br /> Adjacent Structures: N/Ig Wetland: �V/�} <br /> Building Height: Def. Hgt. ���S Peak Hgt. ���� <br /> Lot Coverage: �y•3 <br /> Grading: Staff Approval Date: �' �� � i 7 By: �� , Council Approval Date: J�'�'�1 <br /> Septic: Staff Approval Date: N t ra By: ;;�°. <br /> Zoning File: # Zc�s3g Resolution: /# Resolution Date: S- l3-�7 <br /> Shoreland Dist:ict: y�_5 <br /> Avg. Setback: Nr�} Bluff Setback: ,v�� L.otCoverage: ,vlq <br /> Existing Proposed <br /> Hardcover: 0-75' c o <br /> 75-250' S•9 �l� �•! <br /> � 250-500' Y S. 5 `�� `t�•Z- <br /> 500-1000' <br /> Hardcover Variance Required: Yes�_ No Date of Council Approval: 5-13-y i <br /> REMARKS (in house): <br /> � 26 <br />