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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 33�S ('R�(s i A�— (�A`1 ���4 <br /> PID: <br /> DESCRIPTION OF WORK: �1�w ��2.�,� <br /> ZO.vI�1i G REV�W BY: DATE APPROVED: �-� 3-o z. <br /> BUILDING REV�W BY: DATE APPROVED; 5 _� 3-oZ <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes �� No <br /> PLAi�1 REVIEW Yes �/ No SEWER CONNECITON <br /> STATE SURCHARGE Yes � No WATER CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No �� SITEINSPECTION <br /> Number of SAC Units G�,,,c�rA�-,�-,�,p �o,,� �,��OTHER (specify) <br /> ZOl�tIVG C�CK LIST Zoning District: <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres Width S-D Depth <br /> Survey Submitted: Yes�_ No Date of Survey: 9��3��Z <br /> Proposed Setbacks: <br /> F�e�t (Lake): �'3' t Right Side: �7• � <br /> I��� �- Left Side: <br /> F�ear (Street): c�r,� �I •b <br /> Adjacent Structures: {N�/� Wetland: N l J+� <br /> Building Hei;ht: Def. Hgt. ZS ` Peal:Hgt. 3 c� ' <br /> Lo[Coverage: �SVJ 5� �r � <br /> Grading: Staff Approval Date: �i-�3•�L By: d�0� Council Approval Date: <br /> Septic: Staff Approval Date: nl I ra By: <br /> IZoning File: # UI-2'13� Resolution: # �I760 Resolution Date: Z-Z�• o Z <br /> Shoreland District: y�p 5 <br /> Avg. Setback: �,cc Bluff Setback: N(� I.ot Coverage: — <br /> Eusting Proposed <br /> Hardcover: 0-75' 23�b <br /> � 75-250' s3�H <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes_� No Date of Council Approval: <br /> REMARKS (in house): ���� �-��' � l�.�5 <br /> T <br /> 7 <br />