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t <br /> CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: � 3 �, �;t{�.,.� � C.E..,�`,�a <br /> PID: ' <br /> DESCRIPTION OF WORK • , �,,� =y��,;;-�-,�-Z �,. ,., <br /> -------------------------------------------- -------------------------------------------------------------------------- <br /> ZONING REVIEWBY: _ � DATE APPROVED: � - P� - c;� <br /> B UILDING REVIEW BY.• ' r� DATE APPROVED: �-(� -c:� <br /> _________________________��_______________1 ��______�____ _ ___�____________________�_____�_______________�____���__�___ <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes �/' No <br /> PLANREVIEW Yes ✓ No SEWER CONNECTION <br /> STATE SURCHARGE Yes_� No WATER CONIVEC770N <br /> IIVVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITE INSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING CHECK LIS7' Zoning District: (��„-1� <br /> Fire Department: ��.�,1i�,..,� Post Office:��,�,-Z���1 School District.• �✓,��..� <br /> T' <br /> LotArea: Sq.ft. nto t' �� Acres — Width �/1,2-i,'�., ,,.�-�Depth <br /> Sun�ey Submitted: Yes� No Date of Survey: <br /> Proposed Setbacks: <br /> Front (Lake): �(; � Right Side: � 2 1 <br /> Rear (Street): '�7� Left Side: ' � <br /> Adjacent Structures: ,�4 rT�c;�t�-�e� Wetland: /�i!f�- <br /> Bui[ding Height: Def. Hgt. (�- !G- Peak Hgt. L. IL <br /> Lot Coverage: j L``7� = <br /> Grading: Staff Approval Date: _ �- i(,,- c7� By:� Council Approval Date: <br /> Septic: Staff Approval Date: ,v i� By: <br /> Zoning File:. # — Resolution: # - Resolution Date: � . <br /> Shoreland District: /�`✓ <br /> Avg. Setback: Bluff Setback.• Lot Coverage.• <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Yariance Required: Yes No Date of Council Approval: � <br /> REMARKS(in house): <br /> 32 <br />