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� CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 43�(� l^—c�2��"� �-rt�-�s c�►v�P <br /> PID: <br /> DESCRIPTION OF WORK: e cac <br /> -- �--------------------------------.----Y!��-vo <br /> ZO�'G REV�W BY: DATE APPROVED• <br /> BUILDPi 1G REV�W BY: DATE APPROVED; c�_ �7 -v� <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 WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONI�IG CH�CK LIST Zoning District: L2 -I� <br /> Fire Department: NW v r,� Post Office: M�.��� School District: w�s-r-o n�l� <br /> Lot Area: Sq.ft.Wv C rar4n<<,.� Acres Width Depth <br /> Survey Submitted: Yes�_ No Date of Survey: S-�Z - �i <br /> Proposed Setbacks: <br /> Fron[(Lake): � 2�-( � 1" Right Side: 5�b� �-` <br /> � <br /> Rear (Street): �2 S� � Left Side: � �� <br /> Adjacent Structures: ia�r�'v-�C t�+e.� Wetland: — <br /> Building Height: Def. Hgt. — Peal:Hgt. -' <br /> Lot Coverage: — <br /> Gradin�: Staff Approval Date: -- By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # � Resolution: # Resolution Date: <br /> Shoreland District: ` <br /> Avg. Setbac : N//+ Bluff Setback: N�� L.ot Coverage: <br /> Ezisting Proposed <br /> Hardcover: 0-75' <br /> 75-250' O��L <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS (in house): <br /> 7 <br />