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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: l �S ,���=O c cz �on✓� 1Zo�� <br /> PID: <br /> � DESCRIPTION OF WORK: �eTqGi�c:..—►� A 6c- <br /> Z0.�1G REVIEW BY: DATE APPROVED: l I -I Z-0 3 <br /> BUILDING REVIEW BY: DATE APPROVED; 1 l - � '�--�.? <br /> FEES TO BE CHA.RGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAl�T REVIEW Yes v� No SEWER CONNECTTON <br /> STATE SURCHARGE Yes �/ No WATERCONNECITON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZONING CH�CK LIST Zoning District: . <br /> Fire Department: Post Office: School District: � <br /> Lot Area: Sq.ft. zl�S 2�.3 Acres Width Depth <br /> Survey Submitted: Yes x No Date of Survey: I � • !t • c�'? <br /> Proposed Se[backs: <br /> Front(Lake): � �� ; Right Side: `�� �' <br /> Reaz (Street): 7 p� -� Left Side: �S <br /> Adjacent Structures: , Z ' Wetland: N/r� <br /> Building Hei;ht: Def. Hgt. U. 1� Peal:Hgt. — <br /> L,ot Covera?e: N I /} <br /> Grading: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # — Resolution: # Resolution Date: <br /> Shoreland Districr. N a <br /> Avg. Setback: Bluff Setback: L.ot Coverage: <br /> Existing 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 /> REI�ZARKS (in house): <br /> 7 <br />