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. CHECK O�F' LIST FOR ISSUANCE OF PERMITS <br /> ' FOR OFFICE USE ONLY <br /> A.DDRESS OR LEGAL: ��y p �3 pt�NS Po,n�r (Lo A� <br /> PID: <br /> DESCRg'TION OF WORK: y��� i2,C-S t (�c��c,��--�o l�A R�c�cs. <br /> ZONING REVIEW BY: DAT�APPROVED: 5'- �- `i� <br /> BUII�DING REVIEW BY: DATE APPROVED: 5�- � - �}� <br /> F'EES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes r/� No <br /> PLAN REVIEW Yes ,� No SEWIIZ CONNEC"ITON <br /> STATE SUR`HARGL Yes _� No WA'I'ERCONNECITON <br /> INVESTIGA'I'ION FEE Yes No PARK FEE <br /> SAC Y;:s No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZOi�1Ii�G CHECK LIST zoning District: _ L2-/3 <br /> Fire Department: (�p N(,(J�1� Post Office: (kt,[.E� School District: (4 f1��Vo <br /> LotArea: Sq.ft. 5�7a(��3-� Acres _ �,3( Widch �'� S Depth 3Zb 6Q✓� <br /> Survey Submitted: Yes DC No Da[e of Survey: �/-/Z� S$ <br /> �?�5 . De�_6A2�c� i2�5 Aei. G Gc'_ <br /> Proposed Setbacks: <br /> F�e$t (Lake): _ I 21� �' Z6�``-Right Side: I 5 ' + �/� � <br /> 'r <br /> Rear�(Street): 131� �= Z� �=�fr Side: ZO� ��y - � <br /> lZ,tu.s +o <br /> Adjacent Structures: � $� ve� �,�it,t�o�Wetland: Nl� <br /> Building Height: Def. Hgt. Zf�, Peak Hgt. 37 <br /> Lot Coverage: Il�.S`�'' <br /> GradinJ: Staff Approval Date: �'- 5-9�3 By: d�'� Council Approval Date: �//�1 <br /> Septic: Staff Approval Date: /�ttl (� By: <br /> Zoning File; # — Resolution: # — Resolution Date: — <br /> Shoreland DisL-ict: y t 5 <br /> Avg. Setback: c�• IL Bluff Setback: �J �,�I I.ot Coverage: /U.5�o <br /> � Ezisting Proposed <br /> Hardcover: 0-75' 1� <br /> 75-250' � LS °'f� <br /> 250-500' � 2 '.� r <br /> 500-1000' <br /> Hazdcover Variance Required: Yes No_� Date of Council Approval: <br /> REMARbS (in house): <br /> • 26 <br />