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' � CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 3Z�C� (3 0�rv s P o��v-r ��= <br /> PID: <br /> DESCRIPTION OF WORK: I�t t=c-� V�.S <br /> ZO��I�Ti G REV�W BY: DATE APPROVED: 6' � 3 - °r� <br /> BUILDPtG REVIEW BY: DATE APPROVED; (o •� �� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes �L No <br /> PLAN REVIEW . Yes _� No SEWF.R CONNECTION <br /> STATE SURCHARGE Yes v No WATER CONNECTION <br /> I�IVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No � SITEINSPECTION <br /> Number of SAC Units .�.�5� �w O�THER (specify) <br /> ZONING CH�CK LIST Zoning District: C_2- l� <br /> Fire Departmenr. (,u N c,Lq,�.cz Post Office: (p�,v�,(,,k-«:; School District: O�� <br /> Lot Area: Sq.ft. S�,S`1 1 Acres I . Z Width �lo /�-u� Depth z�� `� <br /> Survey Submitted: Yes_ � No Date of Survey: �- � �`r,1 <br /> p.er l-Fv�so /�.e�'• ��,�,� /t,Ev�s t v vJ <br /> Proposed Setbacks: N"°"� ��►2t�e , �,�:� <br /> Fron[(Lake): 7 S � 1 0 � Right Side: Z 5 •b 5 ►20 � � ( u- Zc.� oo m•� <br /> Rear (Street): 91 ��` Left Side: 7 � • 3 � N �' : d' d � <br /> 2� ZS,S <br /> Adjacent Structures: 3�� Wetland: N/ye- <br /> Building Height: Def. Hgt. Z�( Peak Hgt. 3K <br /> Lot Coverage: Q .Ic <br /> GradinD: Staff Approval Date: C9, k- By: � Council Approval Date: <br /> Septic: Staff Approval Date: /v�� By: <br /> Zoning File: # — Resolution: # � Resolution Date: — <br /> Shoreland District: � <br /> Avg. Setback. c9• IL Bluff Setback: �/ �� I.ot Coverage: �' <br /> Eusting Proposed <br /> Hardcover: 0-75' �_ <br /> 75-250' Z S"Zo <br /> 2�0-500' <br /> 500-1Q00' <br /> Hardcover Variance Required: Yes No�_ Date of Council Approval: <br /> REMARKS (in house): <br /> 7 <br />