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, CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> . • FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: r3�S 3 �` �5 cx� tqv � <br /> PID: <br /> DESCRIPTION OF WORK: /�rc_Z„1 �1•�,� <br /> ZOr'Pi tG REVIEW BY: DATE APPROVED: �o-2 z �'i._, <br /> BUII.DL\G REV�`V BY: DATE APPROVED; ,�-��-o� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNiIT Yes ✓ No <br /> PLA1�1 REVIEW Yes � No SEWER CONNECTION <br /> STATE SURCHARGE Yes �/ No WATERCONNECTTON <br /> INVESTIGATION FEE Yes No �/ PARK FEE <br /> SAC Yes N ,/ SITEINSPECTION <br /> Number of SAC�Units ��,E,�,�,y��r,,�� � OTHER (specify) <br /> - — ----�"=�`-�------------------------------------------- --- <br /> ZONIl�'G CH�CK LIST Zoning District: . <br /> Fire Dep�,-�ent: Post OfFice: School District: <br /> Lot Area: Sq.ft. t�c��,�p, Acres . 3`7 Width Depth <br /> Survey Submitted: Yes�_ No Date of Survey: I b•�i-0 3 <br /> Proposed Setbacks: <br /> Front (Lake): 32•`'1 Right Side: i o•��t <br /> Rear(Street): v�� Left Side: � 1��'�3 <br /> Adjacent Structures: �tl �� Wetland: G 7 � � <br /> Building Height: Def. Hgt. Z.'�. •i Peal:Hgt. 33. �' <br /> Lot Covera;e: ly.�b�b <br /> Grading: Staff Approval Date: /� •Z Z-c� By: � Council Approval Date: — <br /> Septic: Staff Approval Date: N ( (a By: <br /> Zoning File: # — Resolution: # Resolution Date: <br /> Shoreland District: y,�� <br /> A�•g. Setback: N(/� Bluff Setback: /t! /A L.otCoverage: / �/-� <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' S-�_ <br /> 500-1000' .3�(��� <br /> Ha.*dcover Variance Required: Yes No oC Date of Council Approval: <br /> REMARKS (in house): <br /> 7 <br />