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� � . <br /> : <br /> CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: y5 O (31(, S S'Lrq�v O <br /> PID: ' <br /> DESCRIPTION OF WORK Nc(,v Ci4��1 <br /> ---------------------------------------------- ------------------------------------------------------------------------- <br /> ZONING REVIEW BY: DATE APPROVED: s -�z-0 3 <br /> BUILDING REVIEW BY: DATE APPROVED: �-_� Z- o� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes �/ No <br /> PLANREVIEW Yes � No SEWER COIVNECTION <br /> STATE SURCHARGE Yes � No WATER COIVNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITE INSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING CHECK LIST Zoning District: <br /> Fire Department: Post Office: School District: <br /> LotArea: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes D� No Date of Survey: 3-L I-U 3 <br /> Proposed Setbacks: ' <br /> Front (Lak�): 1�� -� Right Side: '7$ <br /> Rear (Stre t): 1 I'3� --` Left Side: '7� . � <br /> Adjacent St etures: �!(/� Wetland: N I � <br /> Building Height: Def. Hgt. c�•1L Peak Hgt. c�.�� <br /> Lot Coverage: /�l I,ft <br /> Grading: Staff Approval Date: �$'- ��. -0 3 By: � Council Approval Date: ^— <br /> Septic: Staff Approval Date: By: <br /> Zoning File: #� — Resolution: # — Resolution Date: — <br /> Shoreland District: y�.s <br /> vg. Setback: p.�c. Bluff Setback: Lot 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): sr+rv�-r o.s so_ s� ,� , /+-��y i+�.� va�vf Co: o.� <br /> nrtl- sr�c <br /> 32 <br />