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Y- . <br /> � CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: t S'y 0 (.,on�c, LAk•cr QL.V O <br /> PID: <br /> DESCRIPTION OF WORK: Z n,c� c�(2,u ,/�.00� ,-, a N <br /> -----------------------------__ ----- ------------------------------------------- t�o <br /> ----------------------------- <br /> ZONING REVIEW BY: c� DATE APPROVED: g= � - <br /> BUILDING REVIEW BY: DATE APPROVED: �i - 7- od <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes No <br /> PLAN REVIEW Yes No SEWER CONNECTION <br /> STATE SURCHARGE Yes No WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECK LIST zoning Discrict: L 2-I/� <br /> Fire Department: ��� Post Office: c��� (h1G�School District: __�(tA N O <br /> Lot Area: Sq.ft. Nv Gl-1�cres Width Depth <br /> Survey Submitted: Yes i� No Date of Survey: p� <'t l.l_ <br /> Proposed Setbacks: <br /> Front(Lake): Right Side: <br /> Rear(Street): Left Side: <br /> Adjacent Structures: Wetland: <br /> Building Height: Def. Hgt. Peak Hgt. <br /> Lot Coverage: <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> K- ��`�c�- <br /> Septic: Staff Approval Date: By: �a LI+"' " <br /> Zoning File: # Resolution: # Resolution Date: <br /> Shoreland District: <br /> Avg. Setback: Bluff Setback: L.ot Coverage: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS(in house): <br /> 7 <br />