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CHECK OFF LIST FOR ISSUAN E OF PERMITS <br /> FOR OFFICE USE O LY <br /> ADDRESS OR LEGAL: �-I 35 ��9 4 S I�(J�= <br /> PID: <br /> DESCRIPTION OF WORK: o� ( <br /> ZOrNi G REVIEW BY: DATE APPROVED: �-�s•4 y <br /> BUILDI�i 1G REVIEW BY: , DAT'E APPROVED: '1-�5-4 � <br /> FEES TO BE CHARGED: Misc. Fees alculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW _ Yes v' No SEWER CONNECTION <br /> STATE SURCHARGE Yes i/ No WATERCOivNECTTON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTTON <br /> Number of SAC�Units OTHER (specify) <br /> ZONING CIi�CK LIST Zoning Districc: L2•�(+ <br /> Fire Depar[ment: (,�jNl� (J�c� Post Office: �vG �i4-/� School District: pCtC�/�/l� <br /> Lot Area: Sq.ft. No cl+��C Acres �' Width Depth — <br /> Survey Submitted: Yes 'X No Date f Survey: D� ���% <br /> Proposed Setbacks: <br /> .,�_._. ��_,_. c�7� <br /> Fcont(Lake): Z 3"1 n.a„���uo. <br /> Rear (Street): I 3� Left Side: Z`{� <br /> Adjacent Structures: 2S' Wetland: <br /> Building Height: Def. Hgt. � �/4- Peal:Hgt. <br /> Lot Coverage: '� <br /> Grading: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: "�-� � -q 5 By: • /Lew �9-� 3�� <br /> Zoaing File: # — Resolution: # — Reso tion Date: <br /> Shoreland District: ti0 <br /> Avg. Setback: Bluff Setback: L.ot Coverage: <br /> Ezisting 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 /> 7 <br />