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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: � �1� G�4/L d �-�/ �Ou2.�- <br /> PID: <br /> DESCRIPTION OF WORK: /UL,r,J �5 <br /> ZOr'Pi 1G REV�`V BY: DAT'E APPROVED: I �-2.6 t�t <br /> BUII.DI�i 1G REVIEtiV BY: DATE APPROVED: � c�•?.� •v� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERi1�1IT Yes �/' No <br /> PLA��t REVIEW Yes � No SEWER CONNECITON <br /> STATE SURCHARGE Yes �/ No WATER CONNECTION <br /> INVESTIGATION FEE Yes No �/ PARK FEE <br /> SAC Yes J No SITEINSPECTTON <br /> Number of SAC Units � OTHER (specify) <br /> ZONING C�CK LIST Zoning Districr. <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. SZ�q-1'1 Acres 1 .235 Width ��Z�¢.�:���-f/Z Depth <br /> Survey Submitted: Yes � No Date of Survey: to�I l��(71 <br /> Proposed Setbacks: � <br /> Front (Lake): 35• 5 Right Side: \'3•'3� <br /> Rear (Street): I�5� � Left Side: t"�� <br /> Adjacent Structures: N �1� Wedand: �) (�}- <br /> Building Hei�ht: Def. Hgt. Zo� Peal:Hgt. 2 S ` <br /> Lot Covera�e: �o. 3�d <br /> Grading: Staff Approval Date: I 0- Z� -� � gy; �t�- Council Approval Date: <br /> Septic: Staff Approval Date: �(/ (� By: <br /> Zoning File: # — Resolution: # — Resolution Date: — <br /> Shoreland District: �: <br /> Avg. Setback: /V� Bluff Setback: /I/�/� Lot Coverage: i•3'�° <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' o I'�•9Sb <br /> Hardcover Variance Required: Yes No�_ Date of Council Approval: <br /> REMARKS (in house): <br /> 7 <br />