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, � CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> � FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 15 9 S Qar-l�vs ��� /20,40 <br /> PID: ot�-it�-23 c�o�5 <br /> DESCRIP'I'ION OF WORK: �pp �-r�o� -�o o a 1 (No�s..� <br /> ------------------------------------------------------------------------------------------------:---------------- <br /> ZONING REVIEW BY: �Q DATE APPROVED• �t(• 3- �r 7 <br /> BUILDING REVIEW BY: DATE APPROVED: /(- 3•�i 7 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Yes � No SEWER CONNECI'ION <br /> STATE SUR`I-�ARGL Yes � No WATERCONNECI'ION <br /> INVESTIGA'I'ION FEE Yes No PARK FEE <br /> SAC Y:;s No STTEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONIlVG CHECK LIST Zoning District: (_R- 1(3 <br /> Fire Department: ni 1 - Post Office: W�vG U411.� School District: �j�Z¢�Ivo <br /> Lot Area: Sq.ft. NO GN��'Acres : Width — Depth — <br /> Survey Submitted: Yes C No Date of Survey: �N b=�� <br /> Proposed Setbacks: <br /> Front (Lake): _ ( (���' Right Side: Z��� � <br /> Rear(Street): Z�l 0� 3 Left Side: (o�� � <br /> Adjacent Structures: _"�3� �' Wetland: N//1' <br /> Building Height: Def. Hgt. (�• IL Peak Hgt. (7. �� <br /> Lot Coverage: /l� (lA� <br /> Grading: Staff Approval Date: /lf�/� By: � Council Approval Date: - <br /> Septic: Staff Approval Date: /l� ((a By: — <br /> Zoning File: #�� Resolution: 1# — Resolution Date: — <br /> Shoreland Dis�:ict: �/LS <br /> Avg. Setback: O�}C. Bluff Setback: /��V} L.ot Coverage: C� .�C <br /> � E�tisting Proposed <br /> Hardcover: 0-75' <br /> 75-250' ?�_� ' -� Z 1� <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No � Date of Council Approval: <br /> REMARKS (in house): <br /> � 26 <br />