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� CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: i 3�, o C N C2(L4 P c.d c,c� <br /> PID: <br /> DESCRIPTION OF WORK: zn,� �oati (4�JVj�T oN /�r►-w✓�ec.��.s��� �-�ps <br /> ZO�tI�TG REVIEW BY: DATE APPROVED: 5-i�- o�( <br /> BUII..DI�i IG REV�W BY: DATE APPROVED: .S-� o - o�( <br /> FEES TO BE CHA.RGED: Misc. Fees Calculated By: <br /> PERi1�IIT Yes f No <br /> PLAi�1 REVIEW Yes �/ No SEWER CONNEC"ITON <br /> STATE SURCHARGE Yes � No WATER CONNECTTON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No STTEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CH�CK LIST Zoning District: f.Q��3 <br /> Fire Department: Post O�ce: School District: <br /> I.ot Area: Sq.f[. 2Z,Ss7 Acres .5 Z7 Width �o� Depth <br /> Survey Submitted: Yes� No Date of Survey: 3-►5-o'{ <br /> Proposed Setbacks: <br /> Front (Lake): �0� t Right Side: y0� <br /> Rear (Street): 1 Z�t Left Side: 3Z ' <br /> Adjacent Structures: q�r�rkc�t�►� �Vetland: N�p� <br /> Building Hei�ht: Def. Hgt. �� Peak Hgt. 2 5 <br /> Lot Coverage: b.l� <br /> Grading: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # O�1'Zqb� Resolution: # Resolution Date: 3-!?- U�^( <br /> Shoreland District: ��� <br /> Avg. Setback: v�i ra,�� Bluff Setback: w�,o- LotCoverage: a•�C <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' ya.0 3 39.Z s <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes_� No Date of Council Approval: <br /> REMARKS (in house): <br /> 7 <br />