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- CHECK OFF LIST FOR ISSUAI�TCE OF PERMITS <br /> � FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 3�c3`�3 C��c 2�.� I�1�,�. <br /> PID: <br /> DESCRIPTION OF WORK: A(�� � �- i o�+S / FtA, w.,3�� <br /> ------------------------- ----------------------------------------------------------------------- <br /> ZONNG REV�W BY: �-�� (Q,�,,,,,,,� DATE APPROVED: /o -��- 0 5- <br /> BULLD _I�i'G REVIE�'V BYC��U DATE APPROVED: �o-��-(-o S <br /> F'EES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ./ No <br /> PLAN REVIEW Yes � No SEWER COiVNECTION <br /> STATE SURCHARGE Yes ✓ No WATERCONNECTION <br /> INVESTIGATION FEE Yes No ,/ PARK FEE <br /> SAC Yes No �/ SITEINSPECT`ION <br /> Number of SAC Units OTHER (specify) <br /> --------------------------------------------------------------------------------------------------------------------- <br /> ZO`�i 1G CH�CK LIST Zoning District: <br /> Fire Department: Post Office: School District: <br /> Lot Area: Se.ft. Acres Width Depch <br /> Survey Submitted: Yes�_ No Date of Survey: �e.p-f 2�, Zc,oS <br /> Proposed Setbacks` � t � �+-r e <br /> Front (Lake): -7'-± 7 0�+ R.ight Side: 23'�' 3G.S� <br /> Rear (Street): -l1'= 60� � Left Side: �4�* � �� <br /> Adjacent Structures: ��,� Wetland: /�/ l� <br /> �suiiding Heignt: Def. Hgi. (�.IL rea�:Hbt. <br /> Lot Covera�e: � L �'� <br /> Grading: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zonin� File: # — Resolution: # Resolution Date: <br /> Shoreland District: y-e�j <br /> Av�. Setback: /v Iv4 Bluff Setback: N f� Loc Coverage: �}• 'Z <br /> Existin, Proposed <br /> Hardcover: 0-75' <br /> 7�-250' �, �C <br /> Zso-soo� C 3� <br /> 500-1000' <br /> Hardcover Variance Required: Yes No_�_ Da[e of Council Approval: <br /> �1'�LE�RKS (iIl t10L1Se): <br /> 7 <br />