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� <br /> � � CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY . <br /> ADDRESSORLEGAL: Z�n� Keil� A�2. <br /> PID: <br /> DESCRIPTION OF WORK: s�-t-c�S-'.� <br /> ZO�TING REVIEW BY: DATE APPROVED: s• 2�s-03 <br /> BUII�DING REV�W BY: DATE APPROVED: s-- z$-d3 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓' No <br /> PLAN REVIEW Yes �_ No � SEWER COrfNECTTON <br /> STATE SURCHARGE Yes c/ No WATER CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No STTEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> Z4NING CHECK LIST Zoning Districc: <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.fr. Acres Widch Depth <br /> Survey Submitted: Yes � No Date of Survey: l a •6•8� <br /> Proposed Setbacks: � � <br /> Front(Lake): (37 Right Side: 7� z <br /> Rear(Street): I�� Left Side: loo� = <br /> Adjacent Structures: �o Wetland: i✓/� <br /> Building Height: Def. Hgt. D•(� Peak Hgt. — <br /> Lot Covera�e: 'C��k- <br /> Grading: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # — Resolution: # Resolution Date: . . . <br /> Shoreland Disuict: y�es <br /> Av�. Setback: n�//� Bluff Setback: �v//t LotCoverage: — <br /> Existing Proposed <br /> Hazdcover: 0-75' <br /> 75-250' <br /> 250-500' /6-9% �>.�/�!o <br /> 500-1000' <br /> Hardcover Vaziance Required: Yes No '-- Date of Council Approval: <br /> REviARKS (in house): _ <br /> 7 <br />