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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 3y S rv0 2�-� �R�'2-+,+,� �n►-� _ <br /> PID: <br /> DESCRIPTION OF WORK: v.�. A�� <br /> ZONING REVIEW BY: DATE APPROVED: j'- 3 -o� <br /> BUII�DING REYIEW BY: DATE APPROVED: 3• 3- o J <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT � Yes � No <br /> PLAN REVIEW Yes v No SEWER CONNECTION <br /> STATE SURCHARGE Yes v No WATER CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECK LIST Zoning District: <br /> NM"D <br /> � Fire Department: Post Office: School District: <br /> G <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes o� No Date of Survey: /L•3�• � <br /> Proposed Setbacks: <br /> Front(Lake): f�8l� + Right Side: fo0 � '�' <br /> Rear(Street): �-{S� % Left Side: 3`t3� �= ._. <br /> Adjacent Structures: t$3� �' Wetland: <br /> Building Height: Def. Hgt. I 'z Peak Hgt. t�y <br /> Lot Coverage: /v�A <br /> Grading: Staff Approval Date: S-3 -oJ By: � 0 . Council Approval Date: — <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # — Resolution: �t Resolution Date: <br /> Shoreland District: /w <br /> Avg. Setback: Bluff Setback: I.ot Coverage: <br /> Existing Proposed <br /> Hazdcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS (in house): <br /> 27 <br />