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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 33 3`i L,iu�:�-c�t� r3��y 1��...���.� <br /> PID: <br /> DESCRIPTION OF WORK: a�1� � ;, ��I/ ;?.c wti�;�;__ <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING REVIEW BY: --�' �, f' DATE APPROVED: " . z-� -`t� <br /> BUILDING REVIEW BY: - DATEAPPROVED: z_ • �'..��.- `�-; <br /> -----------------------------------------------�a----------------------------------------------------------------------- <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes �' No <br /> PLAN REVIEW Yes �" No SEWER CONNECTION <br /> STATE SUR`HARGE Yes �-` No WATER CONNECTION <br /> INVESTIGA'I'ION-FEE Yes No -' PARK FEE <br /> SAC Y�s No �=-r SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING CHECK LIST Zoning District: L%C- �� <br /> Fire Department: r`.�,_.�,�,,•;�.� Post Office: { ,,���� i.+_�y'� School District: �,�.+f�=,r o����'� <br /> Lot Area: Sq.ft. G� , U"">'> Acres • %`;' Width �,2 •7? Av� Depth 42•S 7 RVC:� <br /> Survey Submitted: Yes � No Date of Survey: 1 -�Z -`-i 7 <br /> Proposed Setbacks: <br /> Fra�t (Lake): �(5� Right Side: � a'�` <br /> Rear (Street): '`' � Left Side: 2 : <br /> Adjacent Structures: /''�!� Wetland: /��+�� <br /> Building Height: Def. Hgt. v`• �� Peak Hgt. �J -r`= <br /> Lot Coverage: �'��,` � <br /> Grading: Staff Approval Date: N �✓� By: -� Council Approval Date: � <br /> Septic: Staff Approval Date: iJ� i��'` By: -- <br /> Zoning File: # ��<�='? Resolution: �# Resolution Date: Z- 2`f -�� � �� <br /> Shoreland Dist:ict: 'y�S <br /> Avg. Setback: ��}2�qN(,c3 Bluff Setback: (U� ,� L.ot Coverage: Z„3�� �' <br /> Existing Proposed <br /> Hardcover: 0-75' �� �,�s7 `f.�-:37 <br /> 75-250� ,1-., � , �c �� -- <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes :�_ No Date of Council Approval: �.% "�K�7� <br /> REMARKS (in house): <br /> � 26 <br />