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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> �1�+��FOR OFFICE USE ONLY <br /> A.DDRESS OR LEGAL:"`� (�(�w N (Z.o A-�,o /�f a. <br /> PID: <br /> DESCRIPTION OF WORK: ��� 2� , <br /> Z0�1G REVIEW BY: DATE APPROVED: i� - 2� -0 3 <br /> BUII,DI1i 1G REV�W BY: DATE APPROVED; i�- 2�-o�z <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ,� No <br /> PLAi�t REVIEW Yes v No SEWER CONNEC"ITON <br /> STATE SURCHARGE Yes � No AT�RCONNECTTON <br /> INVESTIGATION FEE Yes No � ARK FEE <br /> SAC Yes � No STTEINSPECTTON <br /> Number of SAC�Un.its � � OTHER (specify) �— <br /> - ------__ ____ __-f��' -�,� --;-------�- -- - - - <br /> ZONING CH�CK LIST Zoning District: <br /> �� � � � <br /> Fire Departmenr. Post Office: School istrict: <br /> �� <br /> I.ot Area: Sq.ft. Acres Y� 3� Width z�t�r�, Depch i fzft.�.—�u c,a�2 <br /> Survey Submitted: Yes_� No Date of Survey: 8-�`�-�3 <br /> Proposed Setbacks: <br /> Front (Lake): zZ5� � Right Side: 3c�.� � r <br /> Rear (Street): �Z�� 1 Left Side: `1-$ ' : <br /> Adjacent Structures: N I/� �Vetland: /V(A <br /> Building Height: Def. Hgt. 2Z.S Peal:Hgt. -�� <br /> Lot Coverage: N/A <br /> Grading: Staff Approval Date: �S- 7�3 -0"3 By: � Council Approval Date: <br /> Septic: Staff Approval Date: N l�A By: <br /> Zoning File: # �3- z�sL Resolution: # Resolution Date: �o z�-�� <br /> Shoreland District: ��PS <br /> Avg. Setback: �IA2-�,q,-v� Bluff Setback: ^/�/} L.otCoverage: N�/f� <br /> Ezistine Proposed <br /> Hardcover: 0-75' <br /> 75-250' D I� <br /> 250-500' � <br /> 500-1Q00' <br /> Hardcover Variance Required: Yes No Dz Date of Council Approval: <br /> REMAR]KS (in house): <br /> _, <br /> ��"1 l,t�-1 �C:L�I c��C� �..�.,,�y;1 �=,� <br /> ��r ��;�t��-� - <br /> � <br />