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CHECK OFF LIST FOR ISSUANCE OF PERNIITS <br /> FOR OFFICE USE ONLY • <br /> ADDRESS OR LEGAL: � n� C cz Y s Tlq� G�'Z-E� � O2 <br /> PID: <br /> DESCRIP'TION OF WORK: n �L.-v.� �Z�� <br /> ZOrrPi 1G REY�W BY: DATE APPROVED: �o•Z�-4'�I <br /> BUII.DLr'G REV�`V BY: DATE APPROVED; �o- z.6 -�i� <br /> F'EES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Yes �' No SEWER CO�INECI`ION <br /> STATE SURCHARGE Yes � No `VATERCONNEC"�ION <br /> INVESTIGATION FEE Yes No �' PARK FEE <br /> SAC Yes No � SITEINSPECTION <br /> Number of SAC-Units OTHER (specify) <br /> ZO�tli�i G CH�CK LIST Zoning Districc: R R- �� <br /> Fire Department: L4tci_ Post Office: �s. School District: ort,o�ro <br /> Lot Area: Sq.ft. �l,b`��j Acres Z• o t Width � 190� /kv-Q Depth ��6.3 z ��e <br /> Survey Submitted: Yes_�C No Date of Survey: /�-ZZ-`�'``7 <br /> Proposed Setbacks: <br /> :ront(Lake): �� � Right Side: 3 v � <br /> Rear (Street): 355 � � Left Side: SS � <br /> Adjacent Structures: N 1 � Wetland: N�� <br /> Buildin� Height: Def. Hgt. Z SP> Peak Hgt. 3'� <br /> Lot Covera�e: N �/-� � <br /> Grading: Staff Approval Date: !a- 26- S`I By: �-•v� Council Approval Date: !t//�4 <br /> Septic: Staff Approval Date: /�• 2-6 -�t `� gy; a•�- <br /> Zoning File: # — Resolution: # — Resolution Date: <br /> Shoreland District: Jv� <br /> Av�. Setback: Bluff Setback: Lot Coverage: <br /> Ezisting Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> SQO-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS (in house): <br /> 7 <br />