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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: t���, C3�xrv5 Pe+�,; (��� <br /> PID: <br /> DESCRIPTION OF WORK: �t�� � T�c;� <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING REVIEW BY: : (j�J�-._ DATE APPROVED: � � - {-�f c,: <br /> BLTILDING REVIEW BY: ' � _ DATE APPROVED: '�) � I -� t.., <br /> ------------------------------------------------- ;, -------------------------------------------------------------------- <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes f No <br /> PLAN REVIEW Yes ✓� No SEWER CONNECTION <br /> STATE SUR:�IARCr� Yes � No WATER CONNECTTON <br /> INVESTIGA'I'ION-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-1(3 <br /> Fire Department: �1_R�Z,('� Post Office: �J(�!y Z4 c'74 School District: E�'L-c:a;t8 <br /> Lot Area: Sq.ft. (o�,� �`) t Acres � �`� 1 Width 2 z �� Depth 21� •� i:, <br /> Survey Submitted: Yes �� No Date of Survey: Ei Z-��`f tv <br /> Proposed Setbacks: <br /> Front (Lake): 1�-10� �' Right Side: _S! � + <br /> Rear (Street): � ���� fi Left Side: � S�� `� <br /> Adjacent Structures: !�+'�'}���=-� Wetland: ,N � � <br /> Building Height: Def. Hgt. �,\�— Peak Hgt. O,k <br /> Lot Coverage: �, f L <br /> Grading: Staff Approval Date: ��✓� By: — Council Approval Date: �-- <br /> Septic: Staff Approval Date: N f �k By: — <br /> Zoning File: # 2�6� Resolution: # 3�?`��1 Resolution Date: ��'- �4� `1� <br /> Shoreland Dist:ict: y�5 <br /> Avg. Setback: �.rt Biuff Setback: ��v� LotCoverage: � �/a <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' `� 1<2 ?7.r li <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes v� No Date of Council Approval: �o Z`� ��� <br /> REMARKS (in house): <br /> � 26 <br />