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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: z.'�t� � L A s��v ��„-„T (Z..�;,.a-� <br /> PID: <br /> DESCRIPTIONOFWORK: �`c�,c+� i2�.��4+2 /'��r �,��•t^A-.^�, ��-e..c_-r�-� ����� +G�eE <br /> ------- ---__------------------------- <br /> - -�---- <br /> ZO.�I�1i G REVIE`Y BY: .� .� ------------DATE APPROVED: `-1 Z� ' c`� <br /> BUII.DING REV�W BY: ° ,,. DATE APPROVED: y - -Z-� - �S <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ;/ No <br /> PLAN REVIEW Yes �/ No SEWER CO�tNECTION <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 /> ZONIVG CH�CK LIST Zoning District: `�-I c_ <br /> Fire Department: Post O�ce: School District: <br /> Lot Area: Sq.ft. �,c+� ��4: Acres .�l� Width ���'�``�rv,�.c�,�� Depth <br /> .,i�, :°' )} �.�x.7�/a¢C/L <br /> Survey Submitted: Yes�_ No Date of Survey: Z-z 1 -�i <br /> Proposed Setbacks: <br /> Front (Lake): Right Side: ru6 GE+/'�^k'�- <br /> Rear (Street): Left Side: <br /> Ad;acent Structures: ;' Wetland: ,s��v� <br /> BuildinJ Height: Def. Hgt. ^ra �;.�,a„r.,c, Peak Hgt. — <br /> Lot Covera�e: �,� c�c,� <br /> Gradino: Staff Approval Date: N r a By: Council Approval Date: <br /> Septic: Staff Approval Date: f✓ �/� By: – <br /> Zoning File: # �>"- 3�>�,5 Resolution: # Resolution Date: `�'� S `�`� <br /> Shoreland Distric[: v ps <br /> Avg. Setback �//},r�,;,�.,�,u Bluff Setback: NO�� L.otCoverage: �,�Jc� <br /> Ezisting Proposed <br /> Hardcover: 0-75' ;�Cj'� �i�7� <br /> 75-250' ;�z 2S% <br /> 2�0-500' �_ � ` � <br /> 500-1000' <br /> Hardcover Variance Required: Yes_� No Date of Council Approval: y �2 S.65 <br /> RENIARKS (in house): � (,vo�t K s� w�o �c7u+� �� _ <br /> � <br />