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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 33� �J Av I�CZ� (.?�N� <br /> PID: <br /> DESCRIPTION OF WORK: S 4-�� <br /> ZOrTi 1G REVIEW BY: DATE APPROVED: �p-Z�i --•�t <br /> BUILDTivG REVIEW BY: DATE APPROVED: c o -ZS - �� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PER�v1IT Yes f No <br /> PLAl�t REVIEW Yes ✓� No SEWER CONNECTION <br /> STATE SURCHARGE Yes � No WATEKCONNECTION <br /> ' 'l'''�'t INVESTIGATION FEE Yes � No PARK FEE <br /> � ��� � SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZC3NING CH�CK LIST Zoning Districr. L2-/L <br /> Fire Department: Post O�ce: School District: <br /> Lot Area: Sq.ft. 1,13`� Acres . t k� Width C./7 Depth /5 d � �' <br /> Survey Submitted: Yes pL No Date of Survey: <br /> Proposed Setbacks: � <br /> Front (Lake): I D � Right Side: �0 ' �. <br /> Rear (Street): `��� �' Left Side: Z-�j � ± <br /> Adjacent Structures: LO� t Wetland: — <br /> Building Height: Def. Hgt. � p,�L Peal:Hgt. — <br /> Lot Coverage: � <br /> Grading: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File: # ��Yv Resolution: # �� Resolution Date: /�7 •u�-�� <br /> Shoreland District: n/U <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 /> Hazdcover Variance Required: Yes No Date of Council Approval: <br /> � RENIARKS (in house): �`;Z..�2 1�^° � (?�-vw,.�-- <br /> 7 <br />