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� CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 1�3 3� FA�E2NL SS �„v T /�o� <br /> PID: <br /> DESCRIPTION OF WORK: Qc�c <br /> ZO�'G REVIEW BY: DATE A.PPROVED: ti-ZS -�3 <br /> BUILDTi�tG REVIE`V BY: DATE APPROVID; ri - Z�+� a3 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes _� No <br /> PLAN REVIEW Yes _� No SEWER CONNECTION <br /> STATE SURCHARGE Yes _�/ No WATERCONNECITON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZO�TIi\'G CH�CK LIST Zoning District: <br /> Fire Department: Post Office: School District: <br /> LotArea: Sq.ft. 32ruZZ •Y7 Acres ."1�J Width �/L�Zut�t2 Depth <br /> Survey Submitted: Yes ✓ No Date of Survey: -Z)-OI <br /> Proposed Setbacks: <br /> Fron[(Lake): /�{y �; Right Side: /S� <br /> Rear(Street): "i b� I.eft Side: 6S <br /> Adjacent Structures: flTTY�GM�'7� Wetland: /�/1� <br /> Building Height: Def. Hgt. � Peal:Hgt. — <br /> Lot Covera�e: c�,IL <br /> Grading: Sta�`f Approval Date: — By: Council Approval Date: <br /> Septic: Scaff Approval Date: — By: <br /> Zoning File: # — Resolution: # Resolution Date: <br /> Shoreland District: v�P 5 <br /> Avg. Setback: �l/.} Bluff Setback: �! /r4 L.ot Coverage: — <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' / V•6 C�. {C <br /> 500-1000' <br /> Hardcover Variance Required: Yes No�c_ Date of Council Approval: <br /> REMARKS (in house): <br /> 7 <br />