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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 212� CAR2�K>� L�a-n� <br /> PID: � <br /> D�:,SCRIPTION OF WORK: ,4.�c,l�.� c�,�f,4.6� <br /> ZO\11TG REVIEW BY: DATE APPROVED: 4►- Z, 3- � <br /> BUII,DI�i'G REV�`V BY: DATE APPROVID; q - Z 3-� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes _� No <br /> PLAl�t REVIEW Yes �/ No SEWF,R CONNECITON <br /> STATE SURCHARGE Yes � No WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No STTEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZOi��P1i G CH�CK LIST Zoning District: <br /> Fire Department: Post Office: School District: � <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes_� No Date of Survey: e,,+ i��C' <br /> Proposed Setbacks: <br /> Froat(Lake): I �3� � Right Side: 5"Z) � t <br /> Rear(Street): (�7� '}' I,eft Side: ZSa` �' <br /> Adjacent Structures: _�4�rn4u�,-."'� Wetland: N/fa- <br /> Building HeiVht: Def. Hgt. (�•(< Peak Hgt. <br /> I,ot Coverase: -- <br /> Grading: Staff Approval Date: - By: Council Approval Date: <br /> Septic: Stafi Approval Date: — By: <br /> Zoning File: � — Resolution: # Resolution Date: <br /> Shoreland District: �U <br /> A�•g. Setback: Bluff Setback: L,ot Coverage: <br /> Ezistin; Proposed <br /> H2rdcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Ha:dcover Variance Required: Yes No Date of Council Approval: <br /> REMARbS (in house): <br /> 7 <br />