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f ` <br /> CHECK OFF LIST FOR ISSUANCE OF PERNIITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: Z 8(04�' C r4 S�O �Po r� r �� <br /> PID: <br /> DESCRIPTION OF WORK: �L uc <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING REVIEW BY: , DATE APPROVED: S-lI -S v <br /> BUILDING REVIEW BY: DATE APPROVED: 5-I c -q v <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes r/' No <br /> PLAN REVIEW Yes � No SEWER CONNECTION <br /> STATE SURCHARGE Yes r/ No WATER CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING CHECK LIST Zoning District: G2-/� <br /> Fire Department: ✓►�O��Vp Post Office: vJAyZ�k'(lq School District: W�7-�-4�N1�4 <br /> Lot Area: Sq.ft. 'ZI�'iS7. S Acres • �1�1 Width /S'O Depth /�!S.V5 <br /> Survey Submitted: Yes �C No Date of Survey: 8 ' Z'7 b <br /> Proposed Setbacks: <br /> Front (Lake): � pQ� -�- Right Side: �v ` } <br /> Rear (Street): 3p� � Left Side: (a`8� �_ <br /> Adjacent Structures: iQ77�4GHc_� Wetland: /�/�/� <br /> Building Height: Def. Hgt. /V/�n Peal:Hgt. iU(A-- <br /> Lot Coverage: �j °?� <br /> Grading: Staff Approval Date: .t��l� By: '� Council Approval Date: — <br /> Septic: Staff Approval Date: /� (✓�" By: <br /> Zoning File: # — Resolution: # ' Resolution Date: — <br /> Shoreland District: �e 5 <br /> Avg. Setback: N p}- Bluff Setback: �/�.� Lot Coverage: ��o <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' �Y�►-j r l y�'jo <br /> 500-1000' <br /> Hardcover Variance Required: Yes No� Date of Council Approval: <br /> REMARKS (in house): <br /> 7 <br />