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� CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE Oir7L.Y <br /> ADDRESS OR LEGAL: 36o f3�b �sc�+ � <br /> PID: <br /> DESCRIPTION OF WORK: �Nc� <br /> Z0.�1PTi G REVIEW BY: DATE APPROVED: �U-3� 03 <br /> BUII.D�1G REV�`V BY: DATE APPROVED; �� -�3•�3 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ./ No <br /> PLAi�1 REVIEW Yes �� No SEWER CO\'NECTION <br /> STATE SURCHARGE Yes _��No WATER CO�'NECITON <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. Acres Width Depch <br /> Survey Submitted: Yes_ t� No Date of Survey: o� f/[� <br /> Proposed Setbacks: <br /> Front (Lake}: /$S� 'f Right Side: 10' <br /> Rear (Street): �� 'r I.eft Side: (�7 <br /> Adjacent Structures: �p � Wetland: /�I�" <br /> Building Hei�ht: Def. Hgt. !9./� Peal:Hgt. <br /> Lot Coverage: o �� <br /> Grading: Staff Approval Date: — By: Council Appro�•al Date: <br /> Septic: Staff Approval Date: "" By: <br /> Zoning File: # — Resolu[ion: # Resoluuon Date: <br /> Shoreland District: ti-l5 <br /> Avg. Setback ,,il�,� Bluff Setback: �✓/f1 L.ot Coverage: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' D• (< <br /> 250-500' <br /> 500-1d00' <br /> Hardcover Variance Required: Yes No�_ Date of Council Approval: <br /> RE1�Z4RKS (in house): <br /> 7 <br />