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� ' CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: �Gi� _ �oL� <br /> PID: <br /> DESCRIPTION OF WORK: <br /> ZO�TING REVIEW BY: ,� DATE APPROVED: 2-3•9� <br /> BUII.DING REVIEW BY: DATE APPROVED; z• 3 •Sg <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ,� No <br /> PLAN REVIEW Yes � No SEWER CONNECI'ION <br /> STATE SURCHARGE Yes � No WATERCONNECTTON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No STTEINSPECTION � <br /> Number of SAC-Units OTHER (specify) <br /> ZONING CH�CK LIST Zoning District: R R-1� <br /> Fire Department: (�¢�v 6 lA� Post Office: N K•� School District: (7(2�o,sn <br /> Lot Area: Sq.ft. Z�,�S3$ Acres •6 Z Width /5�• �� Depth 3(oC�•bZ. <br /> Survey Submitted: Yes � No Date of Survey: <br /> Proposed Setbacks: <br /> Front(Lake): ZZ' Right Side: S � � <br /> Rear(Street): N (� Left Side: N �-10� <br /> Adjacent Structures: _ _��-ry�C la�� Wetland: /v 1 A� <br /> Building Height: Def. Hgt. (9, {� Peal:Hgt. - <br /> Lot Coverage: -]•b�� <br /> Grading: Staff Approval Date: n1 �/�- By: — Council Approval Date: — <br /> Septic: Staff Approval Date: /�f (�4 By: — <br /> Zoning File: # 24 2 Resolution: # Resolution Date: ocx 2� � `1 S <br /> Shoreland District: /V O <br /> Avg. Setback: Bluff Setback: Lot 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 /> 7 <br />