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• ' CHECK OFF LIST FOR ISSUAI�tCE OF PERi1�IITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: �(� 6 c� (3 A`-L 5 t�l1-2_ �.b�q-✓J <br /> PID: <br /> DESCRIPTION OF WORK: a L� �, <br /> ZO�'G RE'VIEtiV BY: DA:T'E APPROVED: � l - d o <br /> BUII�DI�YG REVIE`V BY: DATE APPROVED: {g —c -�� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓' No , <br /> PLAN REVIEW Yes v� No SEWER CONNECTION <br /> STATE SURCHARGE Yes �/ No WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No STTEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZO�G CH�CK LIST Zoning District: (Z R-I� <br /> Fire Department: W1.p Post Office: (M,� School Disuict: w 2s,UN Ic.�- <br /> Lot Area: Sq.ft. Acres G 4 Width Ifi/L�:,G vt,�t�,�C. Depth <br /> Survey Submitted: Yes_� No Date of Survey: l� � z 2 ��8 <br /> Proposed Setbacks`. � � <br /> Front (Lake): (Q�� �' Right Side: (0 5 <br /> r �.. <br /> Rear (Street): ,�'a Left Side: 3�0 <br /> Adjacent Structures: y�` Wetland: l�l�rA . <br /> Building Height: Def. Hot. (9 , � Peal:Hgt. — <br /> L.ot Covera�e: -' <br /> Grading: Staff Approval Date: �' By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: /# '� Resolution: # Resolution Date: <br /> Shoreland District: � <br /> Av;. Setback: Bluff Setback: I,ot Covera�e: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcovec �'ariance Required: Yes No Date of Council Approval: <br /> REi�iA.RKS (in house): <br /> 7 <br />