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CHECK OFF LIST FOR ISSUANCE OF PE.K1tiIITS <br /> FOR OFFICE USE ONL Y <br /> ADDRESS OR LEGAL: �i1 v ���G�"°'�� �'" <br /> PID: <br /> DESCRIPTIONOF 6VO.RK: N�w �=� � ��5'T'' a�'ap <br /> ------------------ ----- ---------------------------------------- <br /> ZOtVINGREVXEtVBY: DATEAPPROVED: /v-Z/• oy <br /> B UILDIrYG RE VIEW B Y: DA TE APPRO VBD: �v• Z�- �Y <br /> --------------------------------- <br /> FEES TO BE CHARGED: Nlisc. Fees Cc�lczclated By: <br /> PERI�IIT Yes ✓ No <br /> PLANREVIEGV Yes ✓ tVo SEYVER GON�VECTION <br /> STATE SURCHARGE Yes t/ tVo tiVATER CO�WECTION <br /> I��IVESTIGATIO[V FEE Yes [Vo �� PARK FEE <br /> SAC Yes �Vo oC SITE NSPECTIOtV <br /> Nu�nber of SAC Units ,+�A �-�a•�d� �lt.r,w�T '�'r t�sb�f OTHER (specify) <br /> ----------------------------------------------------------------------------------------- - <br /> ZONING CHECh'LIST Zor�ingDistrict: /«'�� <br /> Fire Departmerrt: Post Office: Schoo!Dish'ict: __.. <br /> Lot.�tren: Sq Jt. Z�;�4'� _Acres $� 6Yidth Depth <br /> Su�vey S«brnitted: Yes�_ No DRte of Survey: g"f�" �'Y <br /> Pr•oposecl Setbacks: �"`'� GM�� <br /> Front(Lake): � •S 1�3 Riglit Side: SO.� S�sS <br /> Renr(Street): 6�1 ��•`� Left Side: 30•5' `'�-2 <br /> Adjncent Sn•ucteu•es: 10` G�etland: N�1�19 <br /> Bctilcfing Height: Def. Hgt. �•�`' Peak Hgt. � <br /> Lot Coverage: � N °?a <br /> Grading.• Staff Approvct!Date: Lb•/S '0�'l By: �._ Counci!Approval Date: <br /> Septic: Stnff�lpprovn!Date: I✓ ��' BY� — <br /> Zoning File: # �Y- 30� Resolution: # Resoltition Date: g'27• d''�{ <br /> Shoreland Dish•ict:��S <br /> Avg. Setback: N'I✓� Bl uff Setbc�ck: /✓��' Lot Cover•age: ���o <br /> Elisting Proposecf <br /> Har•dcover: 0-7.i' <br /> �s-zso� �o �z. s�a <br /> 2SO-SOO' Z�'� <br /> 500-1000' <br /> ffardcover �ariance Requireci: Yes No Date of Council Approval: <br /> REII�lARKS(irt hOuse): <br /> 31 <br />