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. CHECK OFF LIST FOR ISSUA��tCE OF PERMITS <br /> ' FOR OFFICE USE ONLY <br /> AI)DRESS OR LEGAL: Z�5 c� G A 2 0�I N c: A�/�= <br /> PID: <br /> DESCRIPTION OF WORK: N�l�.s (LES <br /> ZO�+Ti i G REVIE`V BY: DATE APPROVED: f� -�- o 0 <br /> BUILDPtG REVIEW BY: DATE APPROVED: � • �-��' <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> pERMIT Yes ✓� No <br /> pLAN REVIEW Yes ✓' No SER�ER COi'�TNEC'I'ION <br /> STATE SURCHARGE Yes �/ No WATERCONNEC'TION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No STTEINSPECTION <br /> Number of SAC�Units ��-,�,T �,�,,,.,.- p,�,�,,.� OTHER (specify) <br /> ZO_�iL�1G CH�CK LIST Zoning District: (_2- <<- <br /> Fire Department: �t M o v iv�p Post Office: W Ay z✓�-i� School District: w e s�^�►� <br /> Lot Area: Sq.ft. 3S,v�o Acres •S Width �2cz.e6��2 Depth — <br /> Survey Submitted: Yes � No Date of Survey: S-�d"�� <br /> Proposed Setbacks: <br /> F�ent(Lake): i V�� }' Right Side: t �` <br /> R�(Street): 30.3 Left Side: ��� <br /> Adjacent Structures: N I la Wetland: — . <br /> Buildin� Heigh[: Def. Hgt. (� Peal:Hgt. 21•5 <br /> Lot Covera�e: I("70 <br /> Grading: Staff Approval Date: �• � -�� By: �v- Council Approval Date: <br /> Septic: Staff Approval Date: -- By: <br /> Zoning File: # — Resolution: # — Resolution Date: — <br /> Shoreland District: yeS <br /> Av�. Setback: p.�c Bluff Setback: /�1 1 A L.oc Coverage: �I°ro <br /> Existing Proposed <br /> Hardcover: 0-75' o n <br /> 75-250' 2 3.9 <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No DC Da[e of Council Approval: <br /> gEl�iP,RKS (in house): <br /> 7 <br />