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' � � CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> , ADDRESS OR LEGAL: I►l S (,3/1��.�s /Lo� S'o , <br /> PID: <br /> DESCRIPTION OF WORK: Q�,� _ <br /> ZO�'G REVIEW BY: DATE APPROVED: .�-22-a3 <br /> BUILDING REV�W BY: DATE APPROVED: 5-- LZ-v? <br /> FEES TO BE CHA.RGED: Misc. Fees Calculated By: <br /> PERMIT Yes �/ No <br /> pLAN REVIEW Yes ✓ No SEWER CONNECTTON <br /> STATE SURCHARGE Yes _�� No WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ---------------------------------------------------------------------------------------------------------------------- <br /> ZOti�i TG CHECK LIST Zoning District: <br /> Fire Deparcment: Post Office: School District: <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes�_ No Date of Survey: (� -(���Z <br /> Proposed Setbacks: � <br /> Front (Lake): �I� � Right Side: 1 S �- ��GG� r S 4 30" o r=i= C�(h/� <br /> � /�,�v/J ,s �! s 1/1-�. 11D'r C.��•.•e <br /> Rear (Street): � 3 � Left Side: `-►�t � Nor� a� C�UCRoacHMa,�' <br /> Adjacent Structures: � 22' Wetland: N/�" <br /> Building Height: Def. Hgt. N �� Peal:Hgt. '- <br /> Lot Covera�e: /U� <br /> Grading: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # — Resolution: # Resolution Date: . , <br /> Shoreland District: N v <br /> Av�. Setback: Bluff Setback: Lot Coverage: <br /> Exisiing 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 />