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CHECK OFF LIST FOR ISSUANCE OF PERNIITS <br /> FOR OFFICE USE ONLY <br /> ADDRESSORLEGAL: 3lSd C�qs� RYE <br /> PID: <br /> DESCRIP'TION OF WORK: pE�cHE� (��42��� <br /> --------------------------------------------------------------------------------------------------------------------- <br /> ZO�TING REV�W BY: � DATE APPROVED: 5 � <br /> BUII,DING REVIEW BY: DATE APPROVED: S • 2�-�7 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No , <br /> PLAN REVIEW Yes i/ No SEWER CONNECTION <br /> STATE SUR`HARGE Yes �/ No WATER CONNECTION <br /> INVESTIGA'I'ION-FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING CHECK LIST Zoning District: L.R-lC- <br /> Fire Department: W1 pun�0 Post Office: W p�7,q�r1'9 School District: lr3�P9�T�1�4 <br /> Lot Area: Sq.ft. �`�,`��`r.� Acres i �`( Width ! ��% Depth �5•�'`-3 <br /> Survey Submitted: Yes X No Date of Survey: b "��' q� <br /> Proposed Setbacks: 4 ; <br /> Front (Lake): b�� � Right Side: �`� � <br /> Rear (Street): i� ' Left Side: Y�� � : <br /> Adjacent Structures: >'� � t Wetland: /�+' �/1 <br /> Building Height: Def. Hgt. C�• k..- Peak Hgt. C�.l< <br /> Lot Coverage: .� t�4�� <br /> Grading: Staff Approval Date: N � /� By: — Council Approval Date: <br /> Septic: Staff Approval Date: ti`11? BY: — <br /> Zoning File: # Resolution: # Resolution Date: <br /> Shoreland Dist:ict: y P5 <br /> Avg. Setback: �U�/� Bluff Setback: /U I/� L.ot Coverage: � ��7� <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250'S00' i 9"�� r--'�_ <br /> 500-1000' <br /> Hardcover Vuiance Required: Yes No Date of Council Approval: <br /> REMARKS (in house): _ <br /> • 26 <br />