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CHECg OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: C,�' � <br /> PID: ' - <br /> DESCRIPTION OF K'ORK.• NP�✓ Rx-3 <br /> ZONING REi�IEi��BY.• ,�! . DATEAPPROT�ED: rU%��%�'�'"> <br /> BUILDING REi�IER'B y,• DATEAPPROVED: /o - 7. o g <br /> F'EES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes_�� No <br /> P�j��E� Y�S '� N� SEWER CONNECTION <br /> STATE SURCHARGE Yes �/ No NTATER CONNECTION <br /> WVESTIGATION FEE Yes No_�/ p,qRg FEE -- <br /> S�1 C Yes No r SITE INSPECTION <br /> IJumber of SAC Units �'y�y� � .>�_7s OTHER (spec�) <br /> ZONING CHECK LIST Zoning District: � — ;' <br /> Fire Department: Post Office: <br /> School District: <br /> Lot Area: S . • � <br /> 9.ft• Acres '�•• ��j��} Width ,S Depth � �� <br /> Survey Submitted.• YeS �/" No �7 � <br /> Date of Survey: / L�j C7 <br /> Proposed Setbacks: ��e'v- �G�7�U� <br /> � � ��� <br /> Front(Lake): _ � �agl�Side: �d j � <br /> . <br /> � � �� � <br /> Re¢r(Street): �j �j ,�fl Side: �. � � <br /> �i/ ' <br /> `7` G Adjacent Structures: ��' Wetland: /7�°�- <br /> _ � u�nd�' � � �. <br /> /�ra�� Building Height.� Def. Hgt. � ' <br /> ��a•, n��..,l - <br /> Peak Hgt• ��} C�f'fy-��.� -� r,v�k,� <br /> �:�u � <br /> � ll �L-ot Coverage: j �_���' � ('GY�i 2�' C�� ,5 .h c ,�� //'7� �7/�� <br /> �' �t��'�iz <br /> . ��,���� <br /> Grading: Staff,Qpproval Date: �1 �� By.C�zi���tfsr <br /> ^,Council Approval Date: <br /> l��'� � <br /> Septic: Sta}J,4pproval Date: �_�_ By.� <br /> ��1 <br /> Zoning File: # Resolution: #__ Resolution Date: <br /> Shoreland District: ����1''� <br /> MCWD Pe�•mit: f'�J��Q j����� <br /> Avg. Setback: �J/L BluffSetback. C'/L <br /> � �� LotCwerage.• <br /> Hardcover: D-'S' Z� , c��,�., , � �C? <br /> 75-Z50 5� �-_— � <br /> 250-500' ? �� �� <br /> l �>. <br /> SDO-1000' <br /> Hardcover i�ariance Reguired: 7'es No � Date of Council.4pproval: <br /> IZEMARKS(in house): G�C l� �l�l C(c, c�(,Q�/' �l�1 _S�v�� � << � <br /> _ Si vl C L� r� r S 1 �i�-� '� /��'-�- <br /> �2 S l c� eC��C vi+�C(l A hc� �x�� �o��{.� - <br /> �, v��L �—,��/��cG cy!'I frJ l� � <br /> ��-�%��'�<T� /1� � � S��� <br /> � 33 <br />