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CHECK OFF LIST FOR ISSUANCE OF PERVIITS <br /> FOR OFFICE USE ONLY • <br /> ADDRESS OR LEGAL: 31 U't l..,�v�N�sT o t�l , . <br /> PID: <br /> DESCRIPTI0�1 OF WORK: �,�w rz-�:5 <br /> ZO.�i'G REV�W BY: DATE APPROVED: 3-ZS •O o <br /> � BLTII.DIITG REV�W BY: � � DATE APPROYED; 3•Z�-O° <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> pLp�N REV�W Yes ✓ No SEWER CO�fNFCITON <br /> STATE SURCHARGE Yes ,/ No WATERCONNECTION ��� .�'t� <br /> INVESTIGATION FEE Yes No � PARK FEE <br /> SAC Yes � No STTEI�i 1SPECTION <br /> Number of SAC�Units � OTHER(specify) <br /> _�_________________ - --------------- <br /> ZO�Zti'G CH�CK LIST zoning Districr. � R -�c - I . <br /> Fire Department: �vW�,v� Post Office: �_,�,,--� School District: C,:�Psm^.)4c�4 <br /> Lot Area: Sq.ft. 1�9 b5.'12 Acres , o'-t 5� Width 3C�."1 Depth (o`�•�3 <br /> Survey Submitted: Yes X No Date of Survey: Z 'Z �g'aa <br /> Proposed Setbacks: � � <br /> Froat(Lake): Z � '= Right Side: � �'S_ � <br /> . f <br /> Reaz(Street): 6 + I.eft Side: D <br /> Adjacent Structures: �T-r,e�c.�t� a� Wetland: �I►4 <br /> Buildin�Height: Def. Hgt. �•�- Peak Hgt. <br /> Lot Coveraae: N�� ' <br /> Gradin�: Staff Approval Date: v.K By: .��� Council Approval Date: <br /> Septic: Staff Agproval Date: � ��' By: <br /> Zoning File: # Resolution: fi Resoludon Date: <br /> Shoreland District: <br /> Avg. Setback: Bluff Setback: Lot Co�tra�e: <br /> � Ezistmg Proposcd � <br /> r/� Hardcover: 0-?5' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> RED�IARKS ('in house): � <br /> 7 <br />