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� CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 3 y�t�c C_`i 2�C f�v-2 <br /> PID: <br /> DESCRIPTION OF WORK: �,�< <br /> ZO.�i 1G REVIEW BY: DATE APPROVED: (0-2-5 -o� <br /> BUII.DING REVIEW BY: DATE APPROVED; �o• Zq -o� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes _� No <br /> PLAi�t REVIEW Yes r/ No SEWER CONNECITON <br /> STATE SURCHARGE Yes ,/ No WATERCONNECITON <br /> INVESTIGATION FEE Yes � No PARK FEE <br /> SAC Yes No SITEINSPECTTON <br /> Number of SAC Units OTHER (specify) <br /> ZONING CH�CK LIST Zoning Districr. G2 -�L <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. ►3 K S o. Acres .� Width �0 U Dep� I ?�`�S <br /> Survey Submitted: Yes_� No Date of Survey: I Q-1 Z,��1 <br /> Proposed Setbacks: � � <br /> Front(Lake): �(�7 Right Side: .�Z <br /> r � <br /> Rear (Street): �� Left Side: 31.� <br /> Adjacent Structures: 12'}a GANF(,� �Vetland: /v /�L} <br /> Building Height: Def. Hgt. — Peal:Hgt. — <br /> Lo[Coverage: a°�b <br /> Grading: Staff Approval Date: -- By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # — Resolution: # Resolution Date: <br /> Shoreland District: N� <br /> Avg. Setback: Bluff Setback: I,ot Coverage: 9� <br /> Existin; Proposed <br /> Hardcover: 0-75 '� <br /> 75-250' ,��� C� <br /> 250-500' ' � <br /> 500-1000' " � <br /> \\, <br /> Hardcover Variance Required: Yes No Date of Council Approval: � <br /> REMARKS (in house): � �� � W c�21� -��4�� W t Tl�u � , <br /> ��1��� � <br /> 7 <br /> s. <br />