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CHECK OFF LIST FOR ISSUANCE OF PERi�IITS <br /> FOR OFFICE USE ONLY � <br /> `'ADD�SS OR LEGAL: �c�Z t� c=-o x �'��,- <br /> PID: <br /> DESCRIP'TION OF WORK: �r�,�va c� ,r� , M,-� <br /> ---------- - --- -----------------------------------------j=---------- <br /> ZO�Z�TG REV�`V BY: � DATE APPROVED• � is S 9 <br /> BUILDLVG REVIE`V BY: DATE APPROVED; 9 � _rs -�`y <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Yes �/' No SEWER COi�NECTION <br /> STATE SURCHARGE Yes J No `VATERCO�NECTTON <br /> INV�STIGATION FEE Yes No PE1RK FEE <br /> SAC Yes No STTEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZONLVG CH�CK LIST Zoning District: ��L-1� <br /> Fire Department: �� r" Post Office: ��� School District: ��t�r-o <br /> Lot Area: Sq.ft.�pS�,b�i J Acres `1•'7 � Width `�(��. �� Depth �-(g 1 .2'7 �- <br /> Survey Submitted: Yes_�C No Date of Survey: � `9 — 5 9 <br /> Proposed Setbacks: 6Muc�t- �,Ns, b'�`� �n,�-��'°"'�C <br /> Front(Lake): 237 t p Right Side: ' 0 Q S <br /> 36� <br /> Rear (Street): l�2'� 3 d° Left Side: � �' <br /> Adjacent Structures: �o � �_ Wetland: � �A' <br /> Buildin� Height: Def. Hgt. p, �, Peal:Hai. D. 1� <br /> Lot Coverage: � <br /> Gradin;: Staff Approval Date: — B}�: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zonin� File: # —' Resolution: # Resolution Date: <br /> Shoreland District: �U <br /> Av�. Setback: Bluff Setback: L,otCoverage: <br /> Ezisting Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Cotmcil Approval: <br /> RE��IARKS (in house): <br /> 7 <br />