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� CHECK OFF LIST FOR ISSUANCE OF PERMITS . <br /> FOR OFFICE USE ONLY . <br /> ADDRESS OR LEGAL: 2ti c.� G�s� P��.v c- �Lo,a.� <br /> PID: <br /> DESCRIPTION OF WORK: (��-►-�r�,c,.t.L� G,,q���v <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING REVIEW BY: DATE APPROVED: �u-�-o� <br /> BUILDING REVIEW BY: ,.�_ DATE APPROVED: � c�-�f-�� <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 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: G/Z ' ��- <br /> Fire Department: /►il�i)UN� Post Office: �,c� �a-y�n'fi School District: t,v-�s ���.ri�� <br /> Lot Area: Sq.ft. /V J �/y-v9r�KAcres Width ��'ti'�.�-��� Depth <br /> Survey Submitted: Yes � No Date of Survey: �- �"�� �rv i= ��.�.) <br /> Proposed Setbacks: <br /> Front (Lake): ZleO� i Right Side: �d � 't' <br /> � i t <br /> Rear (Street): '3 3 Left Side: `(!� <br /> Adjacent Structures: 3v� � Wetland: <br /> Building Height: Def. Hgt. �� �G Peak Hgt. (� �c <br /> Lot Coverage: U� �`— <br /> Grading: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # — Resolution: # Resolution Date: <br /> Shoreland District: y-�y <br /> Avg. Setback. �• JC Bluff Setback: N //a Lot Coverage: � , /L <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' � <br /> 500-1000' <br /> Hardcover Variance Required: Yes No ,�-, Date of Council Approval: <br /> REMARKS (in house): <br /> 7 <br />