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CHECK OFF LIST FOR ISSUA��ICE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: �l�(60 ���-3T �.i� (�rve�n� <br /> PID: <br /> DESCRIPTION OF WORK: /U�.-W {Lt�-3 <br /> ZO.�tI�1i G RE'VIEW BY: DATE APPROVED: � - I-1- �5 <br /> BUII.Dl�G REVIEW B . DATE APPROVED: �-i � -a� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes � No <br /> PLAN REVIEW � Yes ✓' No SEWF.R CONivECTION <br /> STATE SURCHARGE Yes —� No WATERCONNECTION <br /> INVESTIGATION FEE Yes No _� PARK FEE <br /> SAC Yes No c� SITEINSPECTION <br /> Number of SAC Units ���"ca� �2Q-w�.• OTHER (specify) <br /> -------------------------------------�i�------'�=�3��Z-------------------------------------------------------- <br /> ZO��i G CH�CK LIST Zoning District: L2•�� <br /> Fire Department: Post Office: School Dis[rict: <br /> Lot Area: Sc.ft. I 2,�60 Acres , Z� Widch S`f� @ �� � Dep[h <br /> Survey Submitted: Yes � No Date of Survey: —7- � `05 <br /> Proposed Setbacks: � <br /> Front (Lake): � �3 Right Side: (0.�0 ' <br /> Rear (Street): �d ' Left Side: I 0•4 <br /> Adjacent Structures: /U �(�- wetland: N� <br /> Buildin� Heijht: Def. Hgt. 3a Peal:Hgt. <br /> Lot Covera;e: �j°�� <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: N �A� By: <br /> Zonin� File: � pj-310 Resolution: � Resolution Date: S'`7 '0 5 <br /> Shoreland District: ��5 <br /> Av�. Setbac O.1� Bluff Setback: (U � (� T..ot Covera�e: I 5'7v <br /> E�isting Proposed <br /> Hardcover: 0-7�' p U <br /> 7�-250' 'j�°7O <br /> 2�0-500' <br /> �00-1000' <br /> Hardcover Variance Required: Yes �D _ No Date of Council Approval: S'S -o S <br /> RE1�iARKS (in house): <br /> � <br />