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' CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY • <br /> ADDRESS OR LEGAL: 3�1� rV oR�t s��4o ct� d2 <br /> PID: <br /> DESCRIPTION OF WORK: q p p� n o,�, 1?,�w•c�,ot c_ <br /> ZO�TING REVIEW BY: DATE APPROVED: �i- Z�z- 4, <br /> BUILDPIG REV�W BY: � DATE APPROVED; 9• zz-��r 5 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes v� No <br /> PLAN REVIEW Yes � No SEWER COrtNECTION <br /> STATE SURCHARGE Yes ✓ No WATERCONNECITON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No � ' STTEINSPECTTON <br /> Number of SAC�Units OTHER (specify) <br /> ZONING CH�CK LIST Zoning District: c..tt.-�� . <br /> Fire Department: (�o u,c Post Office: �(�4�c,� School District: p{?,��.�o <br /> —� <br /> Lot Area: Sq.ft. 52.�S� Acres 1.�1 � Width Z �b Depth 2zS <br /> Survey Submitted: Yes ot No Date of Survey: �-3-q�1 <br /> Proposed Setbacks: � <br /> Front(Lake): G2 � '� Right_Side: 3`�� � <br /> Reaz(Street): f b I ' t Left Side: I 3�� �' <br /> Adjacent Structures: N/1� Wetland: /V//� <br /> Building Height: Def. Hgt. (�•I� Peak Hgt. D.(� <br /> Lot Coverage: O�'' ' <br /> Grading: Staff.Approval Date: ,/t/(/} By: -- Council Approval Date: — <br /> Septic: Staff Approval Date: /V J/}- By: <br /> Zoning File: � " Resolution: # -- Resolution Date: . — <br /> Shoreland District: V�� <br /> Avg. Setback:T N'�/�- Bluff Setback: N//� LotCoverage: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' 41.Z z9•Y� <br /> 500-1000' <br /> Hardcover Variance Required: Yes No k- Date of Council Approval: <br /> REMARKS(in house): <br /> 7 <br />