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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> A.DDRESS OR LEGAL: Z�g S K��w A�..e <br /> PID: <br /> DESCRIPTTON OF WORK: NC w �z�S <br /> ZO�ITIG RE'VIEW BY: DAT'E APPROVED: S -3-o�f <br /> BUII.DPIG REVIE�V BY: ,,,_ . DAT'E APPROVED: �3 •3•o�i <br /> FEES TO BE CHA.RGED: Misc. Fees Calculated By: <br /> PERNIIT Yes �/ No <br /> PL?,i�T REVIEW Yes :/ No SEWER CO��INECTION <br /> STATE SURCHARGE Yes r/ No WATERCONNECTION <br /> INVESTIGATION FEE � Yes No ✓ PARK FEE <br /> SAC Yes No �/ STTEINSPECTION <br /> Number of SAC-Units T�vs��� �•�e�- /k� OTHER (specify) <br /> ZONING CH�CK LIST Zonino Districc: . <br /> Fire Department: Post Office: School District: � <br /> I.ot Area: Sq.ft. Z6,9 z S Acres .L i � Width Depth <br /> Survey Submitted: Yes c' No Date of Survey: ►2-�S-O� <br /> Proposed Setbacks: <br /> FMreflt(Lake): �5 Right Side: (�� <br /> Re� (Street): `�� � Left Side: Z 1•� <br /> Adjacent Structures: N��► `Vetland: N�� <br /> Building Height: Def. Hgt. .3 a Peal:Hgt. �1 Y/ ��' <br /> Loc Coveraoe: /�f• 3 <br /> Grading: Staff Approval Date: $- 3-�K gy; .�D .���Council Approval Date: <br /> Septic: Staff Approval Date: n1 �� By: <br /> °Y- <br /> Zoning File: # 3 o3z Resolution: f� Resolution Date: �-Z�•.o y <br /> Shoreland District: ��S <br /> Avg. Setback: o•� Bluff Setback: r �A I.otCoverage: �`�•3 <br /> Ezistine Proposed <br /> Hardcover: 0-75' o <br /> 75-250' 2 Y. q Z <br /> 250-500' �' <br /> 500-2000' <br /> Hazdcover Variaace Required: Yes No�_ Date of Council Approval: <br /> REMARKS(in house): <br /> 7 <br />