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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: Z S� S k C L.l,`�! A�1 l"; <br /> PID: <br /> DESCRIPTION OF WORK: N Ew i L.—,—'s <br /> ZO�1I�ti G REVD�`V BY: DATE APPROVED: �( 1- �r`� <br /> BUILDI�i TG RE'VIEW BY: DATE APPROVED: �-I �I �`�g <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓� No <br /> PLAN REVIEW Yes I� No SEWER CONNECTION <br /> STATE SURCHARGE Yes � No `VATERCONNECTION <br /> INVESTIGATION FEE Yes No r/ PARK FEE <br /> SAC Yes No � SITEINSPECTION <br /> Number of SAC�Units -r/Ih�vsF�� r-�w� OTHER (specify) <br /> ------------------_---------------------------------------��vrw ------------------------------------------------- <br /> ZOIVI�G CH�CK LIST zoning Districc: ( /2.� I(3 _ <br /> Fire Departmenr. (��� Post O�ce: VJ qc.,-z4�-�� School District: Ltire�z��u,4- <br /> I �. <br /> Lot Area: Sq.ft. �-13• I"�v Acres • �� Width �(�-�Uc-7�c�-�- Depch 3`� v <br /> Survey Submitted: Yes�_ No Date of Survey: ��31' �� <br /> Proposed Setbacks: , <br /> F�eat(Lake): I tb� } Right Side: l 2. . <br /> Rear(Street): I 5 5 � t Left Side: � $•SC� <br /> Adjacent Structures: N(/.� Wetland: /� I A <br /> Building Height: Def. Hgt. 3D Peal:Hgt. 3� <br /> Lot Coverage: t�•7 <br /> Grading: Staff Approval Date: �L` Z� `� `� By:c��' �•'�`Council Approval Date: -- <br /> Septic: Staff Approval Date: N�I� BY� <br /> Zoning File: # Zy Z6 Resolution: # 4 2.c� � Resolution Date: �-Z`�i�9� <br /> Shoreland District: �,�e5 <br /> Avg. Setback: c�•1� Bluff Setback: /J//-� L.o[Coverage: �a•�( <br /> Ezisting Proposed <br /> Hardcover: 0-75' �.3 6.3 <br /> 75-250' Z`�.S � 2�'� <br /> 250-500' (o�.S 3�.�' <br /> 500-1000' <br /> Hardcover Variance Required: Yes�_ No Date of Council Approval: /1''Z-`�'�� <br /> REMARKS (in house): <br /> 7 <br />