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� ' CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY • <br /> ADDRESS OR LEGAL: 2 3� � Q Ay v i�W �cA cA. <br /> PID: <br /> DESCRIPTION OF WORK: ��T Ac.l-��.'�J (9a4M(�c. <br /> ------___-------------------------------- --------------------------------------------�--------------- <br /> Z0�1NG REVIEW BY: DAT'E APPROVED: Z`1 - �t�7 <br /> BUII.DI�1G REVIEW BY: DATE APPROVED; �J-Z:�( - �� __ <br /> F'EES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes � No <br /> PLAN REVIEW Yes �/' No SEWER CONIVECTION <br /> STATE SURCHARGE Yes �/ No WATERCONNECTTON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZO�IG CH�CK LIST Zoning District: C^�' � �- <br /> Fire Department: W�.(�U✓�1� Post Office: W ►'���z�4 r�'� School District: w�- `>�� �`'�� <br /> Lot Area: Sq.ft. 3 Z,��v Acres �� � Width � t2 2�c��� Depth — <br /> Survey Submitted: Yes < No Date of Survey: <br /> Proposed Setbacks: � <br /> r <br /> Front(Lake): �((� T Right Side: r S �' <br /> Rear (Street): 7�� r I.eft Side: 1 �( 43 � t <br /> Adjacent Structures: 2° � Wetland: /J�� <br /> Buildin� Height: Def. Hgt. O,k-- Peal:Hgt. � <br /> Lot Coverage: C�•(�- � <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 /> Avg. Setback: Bluff Setback: Lo[Coverage: <br /> Ezisting Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS (in house): <br /> 7 <br />