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. _� <br /> CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY . <br /> ADDRESS OR LEGAL: �/5 9 O ivo2Tt/ fI/Ltn D2 <br /> PID: <br /> DFSCRIPTION OF WORK: i4ov i n o.�J <br /> ZO�tING REVIEW BY: DATE APPROVED: �t-3 n -�3 <br /> BUII..DING REVIEW BY: DATE APPROVED: p_3� - �3 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> pERMIT Yes � No <br /> pLAN REVIEW Yes l/ No SEWER CONNECTION <br /> STATE SURCHARGE Yes �/ No WATER CONiVECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTTON <br /> Number of SAC Units OTHER (specify) <br /> ZOti'ING CHECK LIST Zoning District: <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres Wid[h Depth <br /> Survey Submitted: Yes_�, No Date of Survey: 9•2'3-0 3 <br /> Proposed Setbacks: <br /> Front(Lake): 112 � Right Side: 10�•3 <br /> Reaz(Street): /50 I.eft Side: t c�b <br /> Adjacent Structures: 7L� Wetland: �✓'/� <br /> Building Height: Def. Hgt. p.lL Peak Hgt. <br /> Lot Covera,e: O,Ic <br /> Grading: Staff Approval Date: — By: Council Approval Date: <br /> _ 3 �x�sn�,S a�a�a»..s + � a�,wow, = y <br /> Septic: Staff Approval Date: �r— By: — -gyst�.'� O�esi�,,•,e9 ��ti ti <br /> T Sruoy 2oor� sffts8�,�� �..i :r+�i�w� .oN� ,t <br /> Zoning File: # - Resolution: # Resolution Date: Na r h �ce�t� !o Ruo.�.< <s <br /> nraT �a Q�cP.wo-r-� <br /> Shoreland Disuicr, y <br /> Av?. Setback. �v//a Bluff Setback: �/�,�'— LotCoverage: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' d. �� <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No� Date of Council Approval: <br /> RENIARKS (in house): �� <br /> 7 <br />