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� � <br /> . _ r CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: /0 r5 L��,OC�'v la4�Vt'_ <br /> PID: <br /> DESCRIPTION OF WORK: ��:�.K <br /> , <br /> ---------------------------------------------- ----------------------------------------------------�-----r�-*--- ------- <br /> ZONING REVIE� BY: � DATE APPROVED• q�; <br /> BUILDING REVIEW BY: DATE APPROVED: <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes v No <br /> PLAN REVIEW Yes � No SEWER CONNECTION <br /> STATE SURCHARGE Yes � No WATER CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING CHECK LIST Zoning District: L�'�a <br /> � v Fire Department: Post Offce: School District: <br /> V_�� Lot Area: Sq.ft. Acres Width Depth <br /> 5urvey Submitted: Yes �C No Date of Survey: p ni (=I l,C� <br /> Proposed Setbacks: � , <br /> Front (Lake): "7� Right Side: (;3 <br /> Rear (Street): N (/� Left Side: l b.S <br /> Adjacent Structures: �T7�Gt�c.� Wetland: Nl/3- <br /> Building Height: Def. Hgt. �//�A- Peak Hgt. /J�/} <br /> Lot Coverage: 0 ./c <br /> Grading: Staff Approval Date: nl (A By: Council Approval Date: <br /> Septic: Staff Approval Date: �1/ //� By: <br /> Zoning File: # -- Resolution: /t -- Resolution Date: --- <br /> Shoreland District: y�PS <br /> Avg. Setback: O.t� Bluff Setback: ^11 A <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' 23 .°► 2� •4 ��.�- /,�en.�w47 ,S�(Z2 <br /> !" <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes I�To_� Date of Council Approval: <br /> REMARKS (in house): <br /> 10 <br />