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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ,�DDRESS OR LEGAL: 3(o Zc� G � �.t�,—L=� S7- <br /> , `FiD: <br /> ` DESCRIPTION OF WORK: � � <br /> ----------------------------------------- ----- --------------------------------------------------------------------- <br /> ZONING REVIEW BY: DATE APPROVED: � -i 2• o( <br /> BUILDING REVIEW BY: DATE APPROVED: (o -� Z�ca� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes c� No <br /> PLAN REVIEW Yes c/' No SEWER CONNECTION <br /> STATE SURCHARGE Yes i/ No WATER CONNECT'ION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING CHECK LIST Zoning District: Ljl- I Y9 <br /> Fire Department: ' Post Office: �t School District: (��20 iv O <br /> Lot Area: Sq.ft. /vo Ctf'�4yvc,C Acres Z -t Width Depth <br /> Survey Submitted: Yes c No Date of Survey: 2 `l`f �"d�j C,� Fr v�� <br /> Proposed Setbacks: <br /> Front (Lake): `�2 � Right Side: �O�{� <br /> Rear (Street): 3�� Left Side: Zy 5� <br /> Adjacent Structures: �c1 � Wetland: /J � �' <br /> Building Height: Def. Hgt. OV' 1/�- Peal:Hgt. N /� <br /> Lot Coverage: N �� <br /> Grading: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File: # /v Iq Resolution: # Resolution Date: <br /> Shoreland District: Y-e5 <br /> Avg. Setback: itJ'(/�' Bluff Setback: y✓�� L.ot Coverage: /✓(� <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' Q. �C <br /> 500-1000' <br /> Hardcover Variance Required: Yes No ,L. Date of Council Approval: <br /> REMARKS (in house): <br /> 7 <br />