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a �-.. <br /> � • <br /> CHECK OFF LIST FOR ISSUA��ICE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 2�t S G���.-���- 14,.-� <br /> PID: <br /> DESCRIPTION OF`VORK: !��/�i r�•�//Lcr3'�,o�c- <br /> ZO�TING REVIEW BY: DAT'E APPROVED: s-zZ-��3 <br /> BUILDING REVIEW BY: DATE APPROVED: s -Zz-� 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 c/ No WATER CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ------------------------------------------------------------------------------------------------------------------- <br /> ZOti�VG CHECK LIST zoning District: <br /> Fire Departmen[: Post Office: School District: <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes�_ No Date of Survey: /-6 -b 3 <br /> Proposed Setbacks: <br /> i <br /> Front (Lake): SS' Right Side: �8 <br /> Rear (Street): 6�' Left Side: `'�3� <br /> Adjacent Structures: � /� Wetland: N/A <br /> Buildin� Hei�,ht: Def. Hgt. U�I� Peak Hgt. �•(� <br /> Lot Covera�e: 12 b °�� <br /> Grading: Staff Approval Date: 5-2'Z-o� By: � Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # — Resolution: # Resolution Date: . . <br /> Shoreland District: t,,,pg <br /> Avg. Setback: �vC/� Bluff Setback: e✓�� I.otCoverage: /2.� <br /> Ezisting Proposed <br /> Hardcover: 0-75' <br /> 75-2�0' <br /> 250-500' </6. I � Zb.y�3 <br /> 500-1000' <br /> Hardcover Variance Required: Yes No�_ Date of Council Approval: <br /> RE�IARKS (in house): <br /> 7 <br />