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• CHECK OFF i.IST FOR iSSUANCE �F PERMITS <br /> � FOR OFFICE USE ONLY <br /> ADDRESS ORLEGAL: <15 �-�c�= �-,M-e 2��6� <br /> PID: <br /> DESCRIPTION OF WORK: Dcu� <br /> ZOV�G RE'VIEW BY: DATE APPROVED: 3-lY- o� <br /> BUILDING REVIEtiY BY: DATE APPROVED; 3-1 Y-oc� <br /> FEES TO BE CI�ARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW � Yes � No SEWER CONNECTION <br /> STATE SURCHARGE Yes _� No WATER CONNECTION <br /> INVESTIGATION FEE Yes No � PARK FEE <br /> SAC Yes No �� STTEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZONING CH�CK LIST Zoning District: . <br /> Fire Department: Post Office: School District: � <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes o� No Date of Survey: o�v 1=i t.t: <br /> Proposed Setbacks: , <br /> Front(Lake): "�c�� �' R.ight Side: �f S ± <br /> Rear(Stree[): I�o� � Left Side: 6�1 fi <br /> Adjacent Structures: �4r»�� Wetland: N /� <br /> Buildin; Height: Def. Hgt. �!/•9 Peak Hgt. — <br /> Lot Coveraae: ���4 <br /> Grading: Staff Approval Date: — By: Council Approval Date: � <br /> Septic: Staff Approval Date: � By: <br /> Zoning File: # — Resolution: # Resolution Date: <br /> Shoreland District: /v c� <br /> Avg. Setback: Bluff Setback: I.ot Coverage: <br /> Ezisting 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 /> �EI�iARKS (in house): <br /> � <br />