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' CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: (��o Q t(� ,�5��4iv� <br /> PID: <br /> DESCRIPTION OF WORK: (��� � r�d� <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING REVIE�J BY: � � DATE APPROVED: � - �o-5� <br /> BUILDING REVILW BY: DATE APPROVED: G - � o -4� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Yes ✓' No SEWER CONNECTION <br /> STATE SURCHARGE Yes _/� No WATER CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING CHECK LIST Zoning District: R 5 <br /> Fire Department: (,on,c, (A��c.� Post Offce: �udn��.s School District: p(I.;e��vU <br /> Lot Area: Sq.ft. /(JO Cl�i4n�j Acres Width /!�/Lt�C�uu-�- Depth <br /> Survey Submitted: Yes �j _ No Date of Survey: i Z-?�-�l. <br /> Proposed Setbacks: <br /> Fmnt(Lake): I�1S� t Right Side: ��' G <br /> I�ear (Street): `1�� �' Left Side: �p� w <br /> Adjacent Structures: I�TTWCI-t�'_� Wetland: N�{R, <br /> Building Height: Def. Hgt. 0 •l� Peak Hgt. D.1�- <br /> Lot Coverage: ���� <br /> Grading: Staff Approval Date: N (/� By: Council Approval Date: <br /> Septic: Staff Approval Date: 6 -!� -9 � By: S •w <br /> Zoning File: # ►� l (�r Resolution: # - Resolution Date: — <br /> Shoreland District: y�3 <br /> Avg. Setback: o ,t� Bluff Setback: /'V l�- <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' � � l<- <br /> 250-500' <br /> 50n-1��0� <br /> Hardcover Variance Required: Yes No� Date of Council Approval: <br /> REMARKS (in house): <br /> 10 <br />