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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY " <br /> ADDRESS OR LEGAL: Z7U C(i���" v� � w ,Q 2 , <br /> PID: <br /> DESCRIP'I'ION OF WORK: (�i��-�� o�+3 �t.Eu�s��^� �r �� p� ��� <br /> ZOrTi�1G REVIE`V BY: DATEAPPROVED: S-w -os <br /> BUILDING REVIEW B : DAT'E APPROVED: 7�o •�s <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes � No <br /> PLAN REVIEW Yes �/ No SEWER COivNECT'ION <br /> STATE SURCHARGE Yes t� No WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> --------------------------------------------------------------------------------------------------------------------- <br /> ZONIVG CH�CK LIST Zoning District: <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres Wid[h Dep[h <br /> Survey Submitted: Yes_� No Date of Survey: �•Z-'�y <br /> Proposed Setbacks: � s, � , <br /> Front (Lake): I,S�� -L Right Side: <br /> Rear (Street): s /D a � '` Left Side: J �� `�' �� <br /> Ad;acent Structures: i1.�rTs¢�.� Wedand: �./>+4- <br /> Building Heioht: Def. Hgt. G •k— Peak Hgt. — <br /> Lot Covera�e: /� I/} <br /> Grading: Staff Approval Date: '—' By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # " Resolution: # Resolu[ion Date: <br /> Shoreland District: <br /> Avg. Setbac . N(A Bluff Setback: /✓(f' Lot Covera?e: it/��a <br /> Ezisting Proposed <br /> Hardcover: 0-75' ���`1 <br /> iZ•3z f zb8 c.�� <br /> 75-250' �D. 'I 2- i`(4 rHo�s� �,�.Oo�rw.� <br /> 2�0-500' 3 ev Q2��.c <br /> 500-1000' S�t� ; `IS�So <br /> Hardcover Variance Required: Yes No_ c� Date of Council Approval: <br /> RE�IARKS (in house): <br /> 7 <br />