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, � <br /> CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 3�..I O N Avr�2 2� �.A N� � <br /> PID: <br /> DESCRIPTION OF WORK: rvc w ��5 o�v �xrhr.iv� Fo�N��+n��1 <br /> ZOY�IG REVIE`V BY: DATEAPPROVED: G� zy—a3 <br /> BUII�DI�i 1G REVIE`V BY: DATE APPROVED; �.Zy-�3 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes _� No <br /> PLAN REVIEW Yes �/' No SEWER CONNECTION <br /> STATE SURCHARGE Yes '� No WATER CONNEC"TION <br /> INVESTIGATION FEE � Yes No P�tK FEE <br /> SAC Yes No c/ STTEINSPECTION <br /> Number of SAC-Units OTHER (specify) <br /> ZONIlVG C�iE.CK LIST Zoning Districr. G2-�c. . <br /> Fire Department: Post Office: School District: • <br /> Lot Area: Sq.ft. �5��7?� Acres . 3 b Width J ZG-5 Depth <br /> Survey Submitted: Yes�_ No Date of Survey: <br /> Proposed Setbacks: <br /> Front(Lake): 3r1� Right Side: 2 Z� <br /> Reaz(Street): 2'"�:�� Left Side: 37� <br /> Adjacent Structures: �v/fl Wetland: N If� <br /> Building Height: Def. Hgt. 2�{ Peak Hgt. 30 <br /> L.ot Coverage: �3•3 <br /> Grading: Staff Approval Date: �.o C I-+�a-r�� By: d� � Council Approval Date: ' <br /> Septic: Staff Approval Date: /�//� By: — <br /> Zoning File: � �'a-3o�y Resolution: /# Resolution Date: � •/�1- 9�/ <br /> Shoreland District: �,PS <br /> Avg. Setback: r�(/a Bluff Setback: N(✓a Lot Coverage: i 3�3 <br /> Existin; Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' 1 I•3 5'.s� <br /> 500-1000' �w.�9 ��.�e3 <br /> Hardcover Variance Required: Yes No Date of Council Approval: C�-� 6-�% o y <br /> REI�ZARKS (in house): <br /> 7 <br />