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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> . ADDRI'.SS OR LEGAL: 1 'U u i�i (� �S�"'� <br /> PID: - � <br /> DFSCRIPTION OF WORK: ry��,.,� i�„j�4 ,�, ���� �, �,�.E-n-�-�,'- <br /> ZONING REVIEW BY: , r ��..— W� � N DATE APPROVED: i�- z�-S 7 <br /> BUILDING REVIEW BY: ,,,�_ DATE APPROVED: << - � - 5 � <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Yes �' No SEWER CONNECTION <br /> STATE SUR`HARGE Yes ✓ No VVATERCONNECTION <br /> INVESTIGAT'ION FEE Yes No PARK FEE <br /> SAC Y:.s No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECK LIST Zoning Disuicr. �Z S <br /> Fire Department: N� v+�u: Post Office: ,�,,,.�-t _ School Districr. dv�-rlc�- <br /> Lot Area: Sq.ft. !V� C N�.wr Acres _ Width — Depth �' <br /> ., Survey Submitted: Yes_� No Date of Survey: i .i�-a� _ <br /> �, <br /> Proposed Setbacks: <br /> Front (Lake): _ �3� Right Side: N�'/�- <br /> Rear (Street): <br /> �v,�•� Left Side: �'�� <br /> Adjacent Structures: �i��`__+ Wetland: r r,/� <br /> Building Height: Def. Hgt. G� k Peak Hgt. v- t� , � <br /> Lot Coverage: /�'//; <br /> Grading: Staff Approval Date: � '�'�' By: — Council Approval Date: ' <br /> Septic: Staff Approval Date: '�' `� BY� <br /> Zoning File: li Zz�- 3 Resolution: A� -3b(: Resolution Date: 3 -Z`f -`' � <br /> Shoreland Disti-icr. y�5 g N�� <br /> Avg. Setback: /��f�. Bluff Setback: � �� I.otCovera e: <br /> Exy��g Proposed <br /> Hardcover: 0-75' <br /> 75-250' d�iC <br /> 250-500' <br /> 500-1000' <br /> Hardcover Vaziance Required: Yes No � Date of Council Approval: ' , <br /> REMARKS (in house): <br /> . <br /> • 26 <br />