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1 � <br /> CHECK OFF LIS7'FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: � j� ���ya,�� �,�,,�� <br /> PID: <br /> DESCRIPTION OF WORK.• ti Z x� b 5�� . <br /> ZONING REVIEW BY.• DATEAPPRO i�ED: �_z�-v <br /> BUILDING REi�IEW BY.• DATEAPPROi�ED: 6 • a 3– u c� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓� No <br /> P���E� Y�S—� N� SEWER CONNECTION <br /> STATE SURCHARGE Yes—�� No WATER CONNECTION <br /> WVESTIGATION FEE Yes No � PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (spec�) <br /> ZONING CHECK LIST Zoning District: i2-S � <br /> Fire Department: Post Office: School District.• <br /> Lot Area: Sg.ft. • Acres Width Depth <br /> Survey Submitted: Yes_ c No Date of Survey; p �,e <br /> Proposed Setbacks: <br /> Front(Lake): _ i U e� �' Right Side: _ �0 � +' <br /> Rear(Street): S-t� r "+' Left Side: �U � �. <br /> Adjacent Structures: � <br /> ,�b Wetland: <br /> Building Height: Def.Hgt. c'.SG. Peak Hgt. <br /> Lot Coverage: � ,/a <br /> Grading.• StaffApproval Date: N ( �A By: Council Approval Date: <br /> Septic: Staf,�'Approval Date: C� ' � [ �� By. � <br /> Zoning File: # Resolution: # Resolution Date: <br /> Shoreland District:�Z.17 MCWD Permit: <br /> Avg. Setback: _ (�_�c., Bluff'Setback. �./!A Lot Coverage: �.q <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-50�' O�� <br /> 500-1000' <br /> Hardcover i�ariance Reguired: Yes No <br /> � Date of Council Approval.� <br /> REMARKS(in house): <br /> 33 <br />