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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> � � FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 2�1�� (J��v w o�/.� /4-•►�P <br /> PID: <br /> DESCRIPTION OF WORK: ()�c,« <br /> ZO.�i 1G REVIEW BY: DATE APPROVED: s''- 23 'a3 <br /> BUII.,DING REVIEW BY: ��Q���, DATE APPROVED: s�-23-�3 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PER1viIT Yes _� No <br /> PLAi�1 REVIEW Yes r/ No SEWER CO�INEC"ITOI�i <br /> STATE SURCHARGE Yes �/ No WATERCONNECTTON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZONING CH�CK LIST Zoning District: <br /> Fire Department: Post O�ce: School District: � <br /> Lot Area: Sq.ft. I�,,oY 3 Acres .y3 � Width I Z`� Depth /S Z.3`{ <br /> Survey Submitted: Yes_� No Date of Survey: 0/v �'-'i� <br /> Proposed Setbacks: <br /> Fron[ (Lake): �p ' t Right Side: 2']3 <br /> Rear (Street): �� -� Left Side: Z 5� t <br /> Adjacent Structures: N(/�- �Vetland: -- <br /> Building Height: Def. Hgt. — Pealc Hgt. <br /> Lot Coverage: N/� <br /> Grading: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # -- Resolution: # Resolution Date: <br /> Shoreland District: �,/.PS <br /> Avg. Setback:T N/y} Bluff Setback: /�/ l✓1- L.ot Coverage: /✓//-1 <br /> Ezisting Proposed <br /> Hardcover: 0-75' <br /> 75-250' o.j� <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No__� Date of Council Approval: <br /> RENLA.RKS (in house): <br /> 7 <br />