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, CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE E ONL Y <br /> ADDRESSORLEGAL: 3SS0 ,rv� ��}PO. <br /> PID: <br /> DESCRIPTION OF WORK �,o p Q, <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING REVIEW BY.• �.- DATEAPPROTrED: <br /> BUILDINGREVIEWBY.• DATEAPPROitED: 3 • �y- o� <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 tiVATER CONNECTION <br /> INVESTIGATION FEE Yes No_�C PARK FEE <br /> SAC Yes No ✓ SITEINSPECTION <br /> Nzmzber of SAC Units OTHER (specify) <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING CHECK LIST Zoning Drstrict: �., — � � <br /> Fire Department: Post Offrce: School District: <br /> ♦ <br /> Lot Area: Sq.ft. Acres �, ��idth �3 Depth �}}t1�2.. Z�d <br /> Siuvey Submitted: Yes No � Date of Sz�rvey: � Q ��, (riu� �� <br /> S�,r„r.t FiY..+,�i!,� U'��- <br /> Pr•oposed Setbacks: n� � � <br /> Front(Lake): �t Side: 3. � <br /> s� � � � <br /> Rear(Street): /7 q L�f Side: <br /> Adjacent StrTrctzires: �'!/} Wetland: rli� <br /> Bcri(ding Height: Def Hgt. Peak Hgt. <br /> Lot Coverage:���� * <br /> Grading: StaffApprova!Date: N 0 GWAn�b(� By: Coia�cil,4pproval Date: <br /> Septrc: Staff�lppr•oval Date: /v 1�/i B}�: <br /> -� 7_onirrg File: # OG� �J2. � Resola�tio�7: � Reso/artioj7 Date: � �� <br /> Shoreland District: ✓ MCGI�D Permit: <br /> rlvg. Setback: BILffSetbacic: LotCoverage: <br /> Exrsting Pi�oposed <br /> Hardcover•: 0-7�' (� Q <br /> 75-�so' �18.Y5� �tpprtn�.d Y5.39%S �� <br /> 250-�00' �' — <br /> soo-�oon� -- - <br /> ��I-furcicover Varinnce Required: }es�� �Vo Date of Cozrncil flppi•oval: ����� <br /> rev�s�r-�. �-o resai�h,� Y`��-7 <br /> REMARKS(in ltouse): <br /> /�/ <br /> By � <br /> » <br />