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- ` CHECB OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: l OS h �w�► U c�J,o�1. <br /> � PID: <br /> DESCRIPTION OF WORK: y s�,�o,s (Jc,n-c,E-t t �ek.t�. <br /> ZONING REVIEW BY: DATE APPROVED: �t-i•9 f� <br /> BUII.DING REVIEW BY: ,,,,,._..= DATE APPROVED: Y- z-q$ <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓' No <br /> pI,AN REVIEW Yes �' No SEWER CONNECTION <br /> STATE SURiHARGE Yes �G No WATERCONNECTTON . <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Y:.s No ' SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONIl�'G CHECK LIST Zoning District: t�R -l(3 <br /> Fire Department: vwa��.e�0 Post Office: fV�-o•}rw� School District: w-P�s%'e+JLr-!� <br /> Lot Area: Sq.ft. 1 Z� Zo'� Acres . �-'8 Width ,J(1.�o�- Depth — ' <br /> Survey Submitted: Yes p� No Date of Survey: 1�'7'g 7 <br /> Proposed Setbacks: � <br /> Fregt(Lake): _ Z� Right Side: 2 S <br /> Reu(Street): �is� Left Side: 2�0� <br /> Adjacent Structures: 14'i"Tl�t��'» Wetland: N 1� <br /> Building Height: Def. Hgt. o��F- Peak Hgt. a. k.. <br /> Lot Coverage: l°L•) <br /> Grading: Staff Approval Date: �v/�- By: — Council Approval Date: — <br /> Septic: Staff Approval Date: N�i4 By: -- <br /> Zoning File; # 23�t'i, Resolution: # Resolution Date: 3- Z3•g�9 <br /> Shoreland Dis�ict: �(P 5 <br /> Avg. Setback: vn2��.,c� Bluff Setback: N�A LotCoverage: i S•� <br /> . E��g Proposed <br /> Hardcover: 0-75' S.3 y.Z <br /> 75-250' SS•y 5 5 <br /> ?SO-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes � No Date of Council Approval: 3-23•S� <br /> 7 <br /> �tE1�ZARKS(in house): �,So's .s1'bN�� • <br /> • 26 <br />