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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY � <br /> ADDRESS OR LEGAL: �y 0 0 62AG�cTrs Po��v-r <br /> PID: <br /> DESCRIP'TION OF WORK: rp�,�. ('�q(1,4co� <br /> Z0�1ING REVIE`V BY: DATE APPROVED: t � � � 'q�r <br /> BUILD�tG REVIEW BY: DATE APPROVED: �n - 3 -�� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes �/ No <br /> PLAN REVIEW Yes �' No SEWER CONNECTION <br /> STATE SURCHARGE Yes r/ No WATERCONNEC"ITON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZO�tG CHE.CK LIST Zoning District: L2-I/4 <br /> Fire Department: nr (�4�c: Post Office: _w AvTa a;-y► School District: o i2o N o <br /> Lot Area: Sq.ft. Acres I 3�AG�-'s Width Depth <br /> Survey Submitted: Yes_ � No Date of Survey: Z-Z�-9 2- <br /> Proposed Setbacks: <br /> F�s�(Lake): I �(o` �' w Right S ide: /7`a�r <br /> LAIc� <br /> R�ar(�&t�eat): 3`8S 3' c Le8 Side: S��� } <br /> Adjacent Structures: �s� Wetland: N�/� <br /> Buildin� Height: Def. Hgt. C�. �� Peak Hgt. �� << <br /> Lot Coverage: /v �/`� ' <br /> Grading: Staff Approval Date: � By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # — Resolution: # Resolution Date: <br /> Shoreland District: ..i,P3 <br /> Avg. Setback: c9-l� Bluff Setback: N �� L.ot Coverage: -- <br /> Ezisting Proposed <br /> Hardcover: 0-75' <br /> 75-250' (9�� � <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No lC Date of Council Approval: <br /> REVIA.RKS (in house): <br /> 7 <br />