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' CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> • FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: �Z�p L,o�q L�,nr�,4 � <br /> PID: - <br /> DESCRIPTION OF WORK: �c�c <br /> ZO�IG REV��V BY: - --- ---------------DATE APPROVED: ----$--Z3-n`� <br /> BUILDI�tG REV�`V BY: DAT'E APPROVED; Q- 2 3-�`� <br /> FEES TO BE CHAKGED: Misc. Fees Calculated By: <br /> PER11�fIT Yes � No <br /> PLA1�T REVIEW Yes r/' No SEWER CONNECTION <br /> STATE SURCHARGE Yes � No WATERCONNECT'ION <br /> INVESTIGATION FEE � Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC�Un.its OTHER (specify) <br /> ZONING CHE.CK LIST Zoning Districc: . <br /> Fire Department: Post Office: School District: � <br /> Lot Area: Sq.ft. 4(�, �6Y• SZ Acres , g 3� � Width 2om•�1 h.•..t Depth Zo 3•a1 I �4�c. <br /> Survey Submitted: Yes�_ _ No Date of Survey: c�� �� ��Q <br /> Proposed Setbacks: <br /> , � <br /> Front(Lake): �2 "� Right Side: '1 $ <br /> Reaz(Street): 10`�' t Left Side: �S� <br /> Adjacent Structures: A����.s-� Wetland: /`��/¢ <br /> Building Hei;ht: Def. Hgt. 0 ,��- Peal:Hgt. -" <br /> Lot Coveraoe: n.K <br /> Grading: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Scaff Approval Date: — By: <br /> Zoning File: # � Resolution: # Resolution Date: � <br /> Shoreland District: �-QS <br /> Avg. Setback: n/'i✓�- Bluff Setback: �/� I.otCovera?e: — <br /> Existing Proposed <br /> Hazdcover: 0-75' <br /> 75-250' <br /> 250-500' / •/ <br /> 500-1000' <br /> Hudcover Variaace Required: Yes No Date of Council Approval: <br /> REMARKS (in house): <br /> 7 <br />