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. , CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> ' FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 3`Oc� C,c.�1 F' s�r-�'�.'� <br /> PID: <br /> DESCRIPTION OF WORK: /�I L�.cJ �ZCS <br /> ZOti�G RE'VIEW BY: DATE APPROVED: �z- Y-�3 <br /> BUII.,DI�1G REV�`V BY: DA'I'E APPROVED: i Z -5 .�i <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> pER11�IIT Yes �/ No <br /> pL?,i�1 REVIEW Yes � No SEWER CONNECITON <br /> STATE SURCHARGE Yes � No WATERCONNECITON <br /> INVESTIGATION FEE Yes No ✓ PARK FEE <br /> SAC Yes No �— STTEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZONLti'G CH�CK LIST Zoning District: . <br /> Fire Department: Post Office: School District: � <br /> Lot Area: Sq.ft. i y�, Sb d � Acres y•3 * Width Depth <br /> Survey Submitted: Ye�. c No Date of Survey: /1- 3'V 3 <br /> Proposed Se[backs: <br /> Front(Lake): ZYo' ± Right Side: 5"a� � <br /> Rear(Street): ���± Left Side: ��� � + <br /> Adjacent Structures: /�) �iA �Vetland: 2 6� <br /> Buildin� Hei�ht: Def. Hgt. Z�3.� Peal:Hgt. 3��� <br /> Lot Covera�e: /�1 1 A <br /> Gradin�: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: I Z- �8 • 0 3 By: /�t.3 <br /> Zoning File: # — Resolution: # Resolution Date: <br /> Shoreland District: N � <br /> Avg. Setback: Bluff Setback: Lot Coverage: <br /> Existin� Proposed <br /> 0 <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' � <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> RENL4RKS (in house): <br /> 7 <br />