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� CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: l�ti 0 c.or3c�R.�o i r� s� <br /> PID: <br /> DESCRIPTION OF WORK: A���n ao•� / (2�,ww�Z. <br /> ZONING REVIEW BY: DATE APPROVED: �I- Y-a 3 <br /> BUII�DING REVIEW BY: DATE APPROVED: �_�- a3 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> pLAl�1 REVIEW Yes � No SEWER CONNECITON <br /> STATE SURCHARGE Yes ,i No WATER CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No STTEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZO��G CI3ECK LIST Zoning District: G!1 •i L <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. 15,'�i2 Acres .35 Width Depth <br /> Survey Submi[ted: Yes _p� No Date of Survey: 1(-I 4• 0 2 <br /> Proposed Setbacks: <br /> Front (Lake): �`'�' Right Side: Z► <br /> Rear (Street): �-(2 � � Left Side: 3`7 <br /> Adjacent Structures: I 3� � Wetland: N/� <br /> Building Heigh[: Def. Hgt. C�-I� Peak Hgt. <br /> Lot Coverage: �1 •9 <br /> Gradin�: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: N f�' By: <br /> Zoning File: # c�2-Z 3 6� Resolution: # Resolution Date: Z-1 n ' u 3 <br /> Shoreland District: u.� <br /> Av�. Setback �v(�- Bluff Setback: N/.� L.ot Coverage: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-2�0' <br /> 250-500' 21. s 2�.2 <br /> 500-1000' <br /> Hardcover Variance Required: Yes No o�- Date of Council Approval: <br /> REMARKS (in house): <br /> 7 <br />