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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> ' FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 3o°t v `�.z�i S.�c�-,� _ A2 <br /> PID: <br /> DESCRIPTION OF WORK:. �l'iL�e� �6�i eLi t�ti+�R paar�o.•i o r= No�sC- <br /> T <br /> --_____�_�____________________�-_�_�__�_= ________ <br /> ZONING REVIEW BY: � C�N�e�_ DATE APPROVED• b �o-�t 1 <br /> BUII�DING REVIEW BY: DATE APPROVED: 6 -��-�1 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes �" No <br /> PLAN REVIEW Yes � No SEWER CONNECTTON <br /> STATE SUR�HARCrE Yes �/ No WATER CONNECITON <br /> INVESTIGATION-FEE Yes -� No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECK LIST zoning Districr. <br /> Fire Department: (.o►vtil-�►ct= Post Office: (•t�n�G���u= School District: b2o,�v <br /> Lot Area: Sq.ft. n�o crtA�nr�c� Acres -- Width — Depth ^ <br /> Survey Submitted: Yes pc No Date of Survey: oa r'��-+= <{-Z S- 8� <br /> Proposed Setbacks: � � <br /> F�eet (Lake): !5� '!" Right Side: �{2. ± . <br /> �esr(Street): 3"t O�� Left Side: L� � '� <br /> Adjacent Structures: AT'Ni�t� Wedand: N�l1 � <br /> Building Height: Def. Hgt. �!//F Peak Hgt. N/l4 <br /> Lot Coverage: <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> �n L Zoning File: # Resolution: # Resolution Date: <br /> �y Shoreland Dis�ict: <br /> L Avg. Setback: Bluff Setback: Lot Coverage: <br /> � Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' � <br /> 250-500' � <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS(inhouse): (1110R1� s77�2T�, �v�o Qvi[.r,�i�vb ��71/�J /T' <br /> • 26 <br />