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�. � � <br /> CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESSORLEGAL: �SS (-'o��sf f}�i5 L�liv� <br /> PID: <br /> DESCRIPTION OF WORK: �qp,n o� / /Lewwo��- <br /> ZO�tING REVIEW BY: DATE APPROVED: �= ��- � 3 <br /> BUILDING REV�W BY: DATE APPROVED: 6 -i�- 0 3 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERiV1IT Yes ✓ No <br /> PLAN REVIEW Yes _,� No SEWER CONNECTION <br /> STATE SURCHARGE Yes 1/ No WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ---------------------------------------------------------------------------------------------------------------------- <br /> Z0ti�1G CHECK LIST Zoning District: <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. s►, i b K•''( ± Acres /•/? f Wid[h /y� Depth 3 G5 s ,a»-* <br /> Survey Submitted: Yes � No Date of Survey: y• S- � z <br /> Proposed Setbacks: <br /> Front (Lake): 263� ± Ri�ht Side: �2� +� <br /> i <br /> Rear (Street): 3g' + Left Side: 3Z' t <br /> Adjacen[Structures: q-r-r�c�-c.� Wetland: n� ��- <br /> Building Height: Def. Hgt. 0 •I� Peal:Hgt. (�.f� <br /> Lo[ Covera�e: •� `�o r <br /> Grading: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # — Resolution: # — Resolution Date: . <br /> Shoreland District: "f 3 <br /> Av�. Setback: ,,� p.,� Bluff Setback: /v�9 L,ot Coverage: y�� <br /> Exis[ing Proposed <br /> Hardcover: 0-75' c� a <br /> 75-2�0' Z.�,,S z-45 <br /> 2�0-500' 32.•9 L Z 9•`1Y <br /> 500-1000' <br /> Hardcover Variance Required: Yes No� Date of Council Approval: <br /> REVLARKS (in house): <br /> 7 <br />