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_ �- i <br /> . CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> � FOR OFF CE USE O,T�TLY <br /> ADDRESS OR LEGAL: ��" S�C� ,�G`-�rz� � Lr��,�;�. ��,�s�� <br /> PID: C� �l-� / �7 -�� 3 :z 3 c� � � �_ <br /> DESCRIPTION OF WORK: <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING REVIEW BY: DATE APPROVED: $-l.-�7 <br /> BLTILDING REVIEW BY: DATE APPROVED: �-I-�i 7 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓' No <br /> PLAN REVIEW Yes ,/ No SEWER CONNECTION <br /> STATE SUR`�IARGE Yes t/ No WATERCONNECTION <br /> INVESTIGAT'ION FEE Yes No PARK FEE <br /> SAC Y:;s No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING CHECK LIST Zoning District: Li�-�r <br /> Fire Department: ���,rv,� Post Office: ���1v,�j School District: w�.s`�u�v ic,,� <br /> Lot Area: Sq.ft. 9�3�5 Acres . 2,i S� Width Sp' Depth I $?.3 A�tt� <br /> Survey Submitted: Yes� No Date of Survey: �1-Zg- 9 7 <br /> Proposed Setbacks: � , <br /> F�ex�(Lake): _ _�� Right Side: � •7 N <br /> Retrr(Street): I y.(o Left Side: Z$� 3 <br /> Adjacent Structures: �g � � Wetland: /U(�4 <br /> Building Height: Def. Hgt. t�� K- Peak Hgt. o•I�. <br /> Lot Coverage: O•� <br /> Grading: Staff Approval Date: D � By: �'� Council Approval Date: <br /> Septic: Staff Approval Date: f`�((�" By: <br /> Zoning File: # ZZ3� Resolution: # Resolution Date: <br /> Shoreland Dist:ict: y�eS <br /> Avg. Setback: N i,� Bluff Setback: ,v// Lot Coverage: O.(C <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' 3� �-- 3�•`1�3 <br /> 250-500' <br /> 500-1000' <br /> Hardcover Vaziance Required: Yes_� No Date of Council Approval: <br /> REMARKS (in house): <br /> � 26 <br />