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, CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> � FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: ll 3 S �OR� A�rn Q�. <br /> PID: <br /> DESCRIPTION OF WORK: Q�U� <br /> ZO�G RE'VIE`V BY: DATE APPROVED: 6 -� 9 -9� <br /> BUII�DING REV�W BY: ' DATE APPROVED: G-°t•g`b <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ,/ No <br /> PLAN REVIEW Yes ✓ No SEWER C0�INECITON <br /> STATE SUR`HARGE Yes ✓ No tiVAT'ERCONNECITON <br /> INVESTIGAZ'ION FEE Yes No PARK FEE <br /> SAC Y:;s No STTEINSPECTTON <br /> Number of SAC Units OTHER (specify) <br /> Z01VI�i'G CHECK LIST Zoning Districr. (.2- t Q <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. �Il.,?S5 Acres 1•07 Width Depth <br /> Survey Submitted: Yes o�_ No Date of Survey: �2 '�g-9� <br /> Proposed Setbacks: , <br /> F�e$�(Lake): _ "Z7 s } Right Side: !7 � <br /> Rear (Street): Z'{(r� '� Left Side: ,�9 � t <br /> Adjacent Struccures: �4'r1lqc,c�� Wedand: �1 lA <br /> BuildinJ Height: Def. H?t. N�i9' Peak Hgt. —' <br /> Lot Coverage: v.l� <br /> Gradin�: Staff Approval Date: h/(�- By: " Council Approval Date: '—' <br /> Septic: Staff Approval Date: /J��'a- By: ! <br /> Zonin� File; # Z3 �2 Resolution: # Resolution Date: 2-Z3•S� <br /> Shoreland Distict: y15 <br /> Avg. Setback: O•(� Bluff Setback: I q� Uu1�/��a�n,G�L.ot Coverage: '�I� S 7� <br /> � Exiscing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' 22.to"? ZS3•S <br /> 500-1000' 9•B`{ �.8� <br /> Hardcover Variance Required: Yes No oL Date of Council Approval: <br /> REMARb'S (in house): <br /> • 26 <br />