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r <br /> CHECK OFF LIST FOR ISSUANCE OF PERMITS � , � <br /> FOR OFFICE USE ONLY <br /> A.DDRESS OR LEGAL: �Z�t 3 C A 5� Po►�r T R�o►an <br /> PID: <br /> DESCRIPTION OF WORK: =c�c �,.. ,� Sc��,.f atiC,�, /o w <br /> ZOYPi 1G REVIEW BY: DATE APPROVED: s-y- o y <br /> BUII.DING REVIEW BY: DATE APPROVED; � Y-o � <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Yes �/' No SEWER CONNECTION <br /> STATE SURCHARGE Yes _�/ No WATERCONNECITON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPEC"TION <br /> Number of SAC�Units OTHER (specify) <br /> ZONING CH�CK LIST Zoning District: L2-I L <br /> Fire Department: Post O�ce: School District: <br /> Lot Area: Sq.ft. /5.7`f� Acres • 3(� Width Depth <br /> Survey Submitted: Yes� No Date of Survey: � �3 <br /> Proposed Setbacks: � <br /> Front (Lake): ��� � Right Side: /T <br /> Rear(Street): /y0� Left Side: �(•5'� <br /> Adjacent Structures: /�zT'+'kc t+G� Wetland: /`l�� <br /> Building Height: Def. Hgt. � •(�- Peal:Hgt. d�� <br /> L.ot Coverage: /5'.( <br /> Gradino: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File: #oy-2949 Resolution: # Resolution Date: y-26- �� <br /> Shoreland District: �.�PS <br /> Avg. Setback: ��(L�,A-r•►ca Bluff Setback: LotCoverage: <br /> Existing Proposed <br /> Hardcover: 0-75' �I��b �Y �� <br /> 75-250' 3 0 �o <br /> 250-500' <br /> 500-1000' <br /> Hudcover Variance Required; Yes No Date of Council Approval: <br /> REMARKS (in house): <br /> 7 <br />