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CHECK OFF LIST FOR ISSUA��tCE OF PERI�IITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 265 S ,p U�� �Z��t -rr���— �:. . <br /> PID: <br /> DESCRIPTION OF WORK: N cr� (Z c�S . <br /> ZO�i'G REV�`V BY: DATE APPROVED: '7• 1(-o 0 <br /> BUILDI�i tG REV�`V BY: DATE APPROVED: -1-ct -o 0 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes _,C No ; <br /> PLAN REVIEW Yes ,/" No SEWER CONIVECTION <br /> STATE SURCHARGE Yes ✓ No WATERCONNECITON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number oz SAC�Units OTHER (specify) <br /> ZONI:�1G CH�CK LIST zoning Districc: (Zv2- ►Q <br /> Fire Department: l.or�6 lJ�}tCh Post Office: (�pr.s(��t(,l� School Disuict: b2oN0 <br /> Lot Area: Sq.ft. Acres z +- Width (2t���t.o.�'t Depch <br /> Survey Submitted: Yes_� No Date of Survey: (i•23-00 <br /> Proposed Setbacks: <br /> Front(Lake): I►U� t' Right Side: 35.1 b <br /> Rear (Street): '3(o O� t Left Side: 34�� �- <br /> Adjacen[Structures: /�j�f� Wetland: /U)� <br /> Building Height: Def. H;t. Peal:Hgt. <br /> Lot Covera�e: IJ�/� <br /> Grading: Staff Approval Date: "7 �II-c9� By: �(L Council Approval Date: � <br /> Septic: Staff Approval Da�e: �' ll' �0 gy; �,�D_ <br /> Zoning File: # — Resolution: # Resolution Date: <br /> Shoreland District: /�� <br /> Avg. Setback: Bluff Setback: Lot Covera�e: <br /> Eusting Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REI�IARKS (in house): �e� i; .^� ���•� ��,�=�.(' (�5 e��� c°�^� <br /> � � Go,N s � �-n.� v� (� ;_� ol.��.►1 �- (3�s.-e�.� �3-.� ���.,-, <br /> t,���i h.e �,� n.�. ti-c-�+,-� �-eR�� � S� s�z:� �5 c��e s c b.J PJ l� <br /> 7 <br />