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Q � � �� � <br /> � �ri�yv�� ���� �.r��,,� ����,�i ,� tiyirl����s=r��.�r��'' <br /> CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFI USE ONLY <br /> ADDRESS OR LEGAL: J (� �� ���� <br /> PID: <br /> DESCRIPTION OF WORK.• •j� ✓ �, � ��N� � <br /> � /�e'y/C� <br /> ��� <br /> ZONING REVIEW BY.• DATEAPPROi�ED: � <br /> B UILDING REi�IEW BY.• DATEAPPRO i�ED: Z -1 -o�3 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: �� �w <br /> PERMIT Yes � No <br /> PLAN REVIEW Yes r/ No SEWER CONNECTIDN <br /> STATE SURCHARGE Yes � No WATER CONNECTION <br /> INVESTIGATION FEE Yes No �/ PARK FEE <br /> SAC Yes No J SITEINSPECTION <br /> Number of SAC Units OTHER (spec�) <br /> ZONING CHECK LIST Zoning District: � 1 ����� <br /> Fire Department: Post Off ce: School District: <br /> i y:r . � � <br /> Lot Area.• Sq.ft. '��.y Z Acres Width Depth �S� <br /> Survey Submitted: Yes � No Date of Survey: Z,7 (J� /'ti/� /4`,3//Q 7 <br /> Proposed Setbacks: /� r�� n� � <br /> Front(Lake): � 7. CJ �i,§t Side: � l�. 10 � �,//''�i'��1� �j�/�i/�j(� <br /> � i <br /> Rear(Street): � � Left Side: �� <br /> Adjacent Structures.• _ j7�_ Wetland: �A' <br /> Building Height: Def. Hgt. Peak Hgt. <br /> Lot Coverage: �� <br /> t"�i��- a�' <br /> Grading.• StaffApproval Date: �'/iy/�Y/Cc� �zp By: �S/�'�;;Council Approval Date: <br /> Septic: StaffApproval Date:� �' ''��'� By. _�� <br /> Zoning File; #_�1'�j' �Z3 Resolution: # <br /> Resolution Date: <br /> Shoreland District.• ✓ MCWD Pe�•mit: <br /> Avg. Setback: � y���- Bluff Setback: /J� Lot Coverage: Q <br /> Existing Pro osed <br /> Hardcover: 0-75' f,/O� Z S�j <br /> 75-250' �� --�--c��_�— <br /> 250-500' <br /> 500-1000' <br /> Hardcover i�ariance Required: Yes�No Date of Council Approval: �Z 0 G� <br /> REMARKS(in house): <br /> 33 <br />