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CHECK OFF LIST FOR ISSUANCE OF PERIVIITS <br /> � FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 31� S �f�S� <br /> PID: � <br /> DESCRIPTION OF WORK: c7 ,— = <br /> ---------------------------------------------------------------------------------------------------------------------- <br /> ZOiVING REVIEW BY: DATE APPROVED: � � l 43-`i�1 <br /> BUII.DLIIG REVIEW BY: DAT'E APPROVED: � -10•g'� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Yes i/ No SEWER CONNEC"TION <br /> STATE SURCHARGE Yes _� No WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING CHECK LIST ZOnirlg Districi: C�'1 C� <br /> � <br /> Fire Department: {NW�w,!J Post O�ce: School District: �,.�e,S���' <br /> Lot Area: Sq.ft. Z,�"�SZ� Acres � � Width �'j o� Depth �� ?(20 �� <br /> Survey Submitted: Yes � No Date of Survey: or� �^tt,c? <br /> Proposed Setbacks: <br /> F=Fe�t(Lake): �(,� Right Side: (0� <br /> � (Street): Z-Z 7 + Left Side: G Z � <br /> Adjacent Structures: �/ ` Wetland: /V�ia <br /> Building Height: Def. Hgt. c�• l�- Peak Hgt. — <br /> Lot Coverage: �y�° <br /> Grading: Staff Approval Date: /U %/� By: — Council Approval Date: '— <br /> Septic: Staff Approval Date: /J (f� By: — <br /> Zoning File: � 2�11 I Resolution: # Resolution Date: _ _ <br /> Shoreland District: .�� <br /> Avg. Setback: u�;�.,� Bluff Setback: N ��"� L.ot Covera?e: I`�`�a <br /> Existing Proposed <br /> Hardcover: 0-75' `{•i y•S <br /> 75-250' �3�.( 3�.( <br /> 250-500' 2�.1 Z�.� <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS (in house): <br /> 7 <br />