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� <br /> , CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> ' FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 2'�Q �l b ��, <br /> PID: <br /> DESCRIPTION OF WORK: SN-c�`�'� <br /> ---------------------------------------------- ---------------------------------------------------------------------- <br /> ZONING REVIEW BY: DATE APPROVED: 6 • I S -g y <br /> BUILDING REVIEW BY: DATE APPROVED: 6 v s -S 5 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERI�IIT Yes �/ No <br /> PLAN REVIEW Yes � No SEWER CONNECTION <br /> STATE SURCHARGE Yes �� No WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONIl�'G CHECK LIST Zoning District: R-S <br /> Fire Department: L.,� L�-,�,�; Post Office: �xs�w School District: <br /> .��__� <br /> Lot Area: Sq.ft. ,�i,� Cl�a Acres — Width — Depth - <br /> Survey Submitted: Yes_� No Date of Survey: p�, -�,(Jt <br /> Proposed Setbacks: � <br /> Front (Lake): I �5 � Right Side: 3 S -� <br /> Rear (Street): 5"a` i= Left Side: 6° ` � <br /> Adjacent Structures: N/!'� Wetland: — <br /> Building Height: Def. Hgt. ���L-- Peal:Hgt. <br /> Lot Coverage: � << <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: I.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 /> REMARKS (in house): <br /> 7 <br />