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, CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 2�`�S c..�-r-,-cx'. O f 2c�-�e.,r'� l,v A H <br /> PID: <br /> DESCRIP'TION OF WORK: N�.c�1 r�.S <br /> ZO�TING REVIEW BY: DATE APPROVED: � • � • g 9 <br /> BUILDING REV�W BY: DATE APPROVED; � • � -S 9 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes � No <br /> PLAN REVIEW Yes � No SEWER CONNEC"ITON <br /> STATE SURCHARGE Yes � No WATERCONNEC"I'ION <br /> INVESTIGATION FEE Yes No � PARK FEE <br /> SAC Yes � No STTEINSPECTION <br /> Number of SAC�Units 1 OTHER (specify) <br /> ZONING CH�CK LIST Zoning District: R 2-�6 <br /> Fire Department: � Post OfFice: �, - School District: pM nra <br /> Lot Area: Sq.ft. 2 + Acres � Width �12.21:`bucJ��2 Depth -- <br /> Survey Submitted: Yes o� No Date of Survey: S'�S-g°7 <br /> Proposed Setbacks: <br /> Front(Lake): (Ip' � Right Side: g Z� 'F <br /> � -� � + <br /> Rear(Sueet): -7 Z- — Left Side: �i L <br /> Adjacent Structures: N(14 Wetland: nl I/a- <br /> Building Height: Def. Hgt. Z9 ` Peak Hgt. 35 � <br /> Lot Coverage: IJ (� ��,�, �R BC�✓r=� <br /> /�ree� ac,��c.� P ��� <br /> Grading: Staff Approval Date: 6 -I-5 5 By: o�U• Council Approval Date: <br /> Septic: Staff Approval Date: /U //� By: — <br /> Zoning File: # — Resolution: # — Resolution Date: — <br /> Shoreland District: ��e S <br /> Avg. Setback: C9.1t Bluff Setback: C�•<< I,otCoverage: <br /> Existing Proposed <br /> Hazdcover: 0-75' '� <br /> 75-250' Z�t-S <br /> 250-500' Z <br /> 500-1000' <br /> Hazdcover Variance Required: Yes No oL- Date of Council Approval: <br /> REMARKS(in house): <br /> 7 <br />