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CHECK OFF LIST FOR ISSU��'CE OF PERI�IITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 3 OZ� l'f� 5 t� PO i N T I�� <br /> PID: <br /> DESCRIPTION OF WORK: (� �c_,�,c <br /> • ____ ___r__ <br /> ZOrT:�'G REVIEW BY: D�TE APPROVED: g - 2_ • d� <br /> BUII.DING REVIE`V BY: DATE APPROVED; � -2. - c� � <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes � No ; <br /> PLAN REVIEW Yes �, No SEWER CONNEC'I'ION <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 /> ZOYL�rG CH�CK LIST Zoning Districr. (.2- � C. <br /> Fire Department: /N p,�n,,n Post Office: w v'v��Ya- School Disuict: c�:se.S�'fl��N� <br /> Lot Area: Sq.ft. !5,3�o Acres . 3 S" �idth �fi(t.�:-�v�►t_ Depth <br /> Survey Submitted: Yes_� No Date of Survey: � 'Z�'Q �I <br /> Proposed Setbacks: i <br /> F-rea[(Lake): 1�1 � Righ[Side: � <br /> Rear (Stree[): I 3 2 Left Side: � � <br /> Adjacent Structures: µ�r�u.,r.e�P Wetland: � t /-1 . <br /> Building Height: Def. Hgt. _ � (✓-I- Peal:H�t. — <br /> Lot Covera�e: z 3 •Z- <br /> Grading: Staff Approval Date: n/�,/s By: — Council Approval Date: <br /> Septic: Staff Approval Date: /v �/a By: - <br /> Zoning File: # ZS�t3 Resolution: #�_ Resolution Date: Y-t 0�Z.�v <br /> Shoreland District: 7,05 <br /> Avg. Setback: v�+.�,�-� Bluff Setback: /�/ ��4- I.otCovera�e: <br /> EzistinQ Proposed <br /> a <br /> Hardcover: 0-75' <br /> 75-250' 7�.i 1 �7•� <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes o� No Date of Council Approval: Y-�n -��o <br /> RENiA.RKS (in house): <br /> 7 <br />