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' ' •� CHECK OFF LIST FOR ISSUANCE OF PERivIITS <br /> FOR OFFICE USE ONLY <br /> � ADDRESS OR LEGAL: �i v430 lJAc-4L fZe�/a-� <br /> PID: <br /> DESCRIPTION OF WORK: c.�4�c z' w c c.e ss 5�4�/L -� 2iz��^�t�nr b w��-�- <br /> ZONING REVIEW BY: DATE APPROVED: s- �s - �1 <br /> BUII�DING REVIEW BY: DATE APPROVED: s'-� 5-�r <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ,/� No <br /> pLpIV REVIEW Yes ✓' No SEWER CONNECTION <br /> STATE SURCHARGE Yes �/ No WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No STTEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ------------------------------------------------------------------------------------------------------- <br /> ZOti1�i 1G CHECK LIST Zoning District: C.2- � � <br /> Fire Department: y1�L�V N � Post Office: INl��v�► � School District: ��l L 5 Tl�v� K-� <br /> Lot Area: Sq.ft. N d C/H4s�Acres Width Depth <br /> Survey Submitted: Yes � No Date of Survey: o til i=i� <br /> Proposed Setbacks: <br /> Front (Lake): Right Side: ��. ���f �`k <br /> Rear (Street): Left Side: <br /> Adjacent Struccures: Wetland: N /�J <br /> Building Hei�ht: Def. Hgt. N �/i Peal:Hgt. N I/� <br /> Lot Covera�e: /�/ /� <br /> Grading: Staff Approval Date: S�15 `n� By:��w � Council Approval Date: QPNd�^� <br /> � <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # — Resolution: # Resolution Date: <br /> Shoreland District: y�p 5 <br /> Av�. Setback. N l� Bluff Setback: e��� I.ot Coverage: � <br /> Existin� Proposed <br /> 0 <br /> Hardcover: 0-75' <br /> 75-2�0' j'V.� <br /> 2�0-500' <br /> 500-1000' <br /> Hazdcover Variance Required: Yes No � Date of Council Approval: <br /> REVIARKS (in house): <br /> 7 <br />