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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> • ' FOR OFFICE US ONLY <br /> ADDRESS OR LEGAL: (,Z� /�c <br /> PID: <br /> DFSCRIPTION OF`�ORK: (�o�,,,Q �o-� <br /> � � -------------------------------------------------------- <br /> Z0�1ING REY�W BY: (�� DAT'E APPROVED: �'�2 9� �$ <br /> BUII.DING RE'VIEW BY: Nt/L DATE APPROVED: <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓� No <br /> PLAN REV�W Yes No ✓ SEWER COivNECTION <br /> STATE SUR`�IARGL Yes r/ No WATERCONNEC"ITON <br /> INVESTIGA'I'ION PEE Yes No PARK FEE <br /> SAC Y::s No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECK LIST Zoning District: - I � <br /> Fire Department:L�� �� ��� {, Post O�ce: (,O�`�G ��C-f� School District: � d�.�l�10 <br /> I.ot Area: Sq.ft. Nd CH1�4s�-�Acres Width Depth <br /> Survey Submitted: Yes No_� Date of Survey: �c TLT �(�,�) <br /> Proposed Setbacks: <br /> Front (Lake): _ Or c�+ Right Side: (4� "~ <br /> Rear (Street): 140 'f' Left Side: �� �" <br /> Adjacent Structures: /U(�(1 Wetland: <br /> Buildin� Height: Def. Hgt. O „IC Peak Hgt. <br /> Lot Coverage: <br /> Gradin�: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoni.ng File; # Resolution: # Resolution Date: <br /> �� . <br /> � Shoreland Dis�ict: . <br /> Avg. Setback: Bluff Setback: LotCoverage: <br /> • Eziscing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REiI�ZAR�S (in h ous e): ��Ji� �/�''V� S d/�1/� � �ti1 � I �� /� I�(J UI� �/'�.t(1 � <br /> � ��� S i� � , � j � J�11�Y.. ,d� �i ��i�. I° E l�;h'� 1�� <br /> • 26 <br />