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CHECK OFFLIST FOR ISSUANCE OFPERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: ?$O N o✓�'k ArW1 <br /> PID: <br /> DESCRIPTIONOF WORK• '� q/�qq� — C� S. . <br /> ZONING REVIEW BY.• �� DATEAPPROVED: 6 <br /> BUILDING REVIEW BY.• (' - i c� - O� DATEAPPROVED: <br /> FEES TO BE CHARGED: Misc. Fees Calculated By.• <br /> PERMIT Yes_� No <br /> PLAN REVIEW Yes �/' No SEWER CONNECTION <br /> STATE SURCHARGE Yes � No WATER CONNECTION <br /> INVESTIGATION FEE Yes No -�/ PARK FEE <br /> SAC Yes No ✓ SITEINSPECTION <br /> 1Vumber of SAC Units OTHER (spec�) <br /> ZONING CHEC%LIST Zoning Districr: L — �� <br /> Fire Department: Post�ce: School District: <br /> / �Lot Area: Sq.ft. Acres � . � Width Depth <br /> Survey Submitted.� Yes�� No Date of Survey: �9 q 7 <br /> Proposed Setbacks: �� � <br /> Front(Lake): 1 .8i�let Side: <br /> Rear(Street): ��' �fi-Side: �� <br /> � <br /> Adjacent Structures: I20 Wetland: <br /> Building Neight: Def.Hgt. _ Z�_ Peak Hgt. � � , <br /> Lot Coverage: qQ9 .$�{ �" Z��� 's � �� <br /> Grading: Sta,�`'Approval Date: By: Council Approval Date: <br /> Septic: StaffApproval Date: BY� Cl� $��•1�- CM �q� S t�� p�hau�,Q, <br /> Zoning File: # Resolution: # Resolution Date: <br /> Shoreland District: �/ MCWD Permit: O <br /> Avg. Setback: �� Bluff Setback: Lot Coverage:� .�"�'Z�j <br /> Existing Proposed �" <br /> Hardcover: 0-75' O Cl/�A,f�Q <br /> 75-250' . n�Z�4�� <br /> Zso-soo- <br /> soa�000� ---» a <br /> Hardcover Variance Required: Yes No � Date of Council Approval: <br /> REMARKS(inhouse): Q�I��aql ►dC 1,000 qve� t3zsar�� <br /> r in Zua� _ <br /> �� ���I'U�� 33 <br />