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4 <br /> � CHECK OFF LIST FOR ISSU�1"CE OF PERMITS <br /> FOR OFFICE USE O:VLY <br /> ADDRESS OR LEGAL: I I�� C�rn�,oa b �1v�. <br /> PID: ' <br /> DESCRIPTION OF WORK �ELK <br /> ZONING REVIEW BY: DATE APPROVED: I I- � 3 •�� <br /> BUILDING REVIEW BY.• DATE APPROVED: � i- ► 3- 03 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes �/ No <br /> PLANREVIEW Yes f No SEWER CONNECTION <br /> STATE SURCHARGE Yes � No WATER CONNEC770N <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITE INSPEC770N <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECK LIST Zoning District: <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres «idrh Depth <br /> Survey Submitted: Yes ,� No Dare of Survey: �- I 6-U 3 <br /> Proposed Setbacks: <br /> Front (Lake): 7 2 � Right Side: Zs � <br /> Rear (Street): '7Z� Left Side: 3�( <br /> Adjacent Structures: ^ Wetland: -- <br /> Building Height: Def. Hgt. — Peak H;t. <br /> Lot Coverage: � <br /> Grading: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approva[Date: -- By: <br /> Zoning File: # U3-24`�I� Resolution: # Rese:lrion Date: <br /> Shoreland District: y�f ,�l <br /> Avg. Setback: � Q�/� Bluff Setback: � �� Lot Coverage: � `/ ! d <br /> Existing Proposed <br /> Hardcover: 0-75' y S6 `�f• S 6 <br /> 75-250' <br /> 250-500' . <br /> 500-1000' f <br /> Hardcover Variance Required: Yes No Date of Council Approi•al: <br /> REMARKS(in house): �:s a `s S�6NGJ ? <br /> 32 <br />