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, <br /> ' " CHECK OFF LIST FOR ISSUANCE OF PERNIITS <br /> ' FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: �115_ I�O RT1�1 Sl�EO(I� pR��C <br /> PID: O�- 11-1 - Z3 �Z (�o► � <br /> DESCR�TION OF WORK: IU C W (2.�5. <br /> ZONING REV�W BY: DATE APPROVED: �-Z• 5 7 <br /> BUII..DING RE`VIEW BY: DATE APPROVED: g -2• �i 7 <br /> FEFS TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes ✓ No <br /> PLAN REVIEW Yes ✓ No SEWER CONNECI'ION <br /> STATE SUR`HAI�C� Yes � No WATER CONNECTION <br /> INVESTIGAZ'ION-FEE Yes No PARK FEE <br /> SAC Yes No STfEINSPECITON <br /> Number of SAC Units OTHER (specify) <br /> ZONlNG CHECB LIST Zoning Districr. c..�t-�(3 <br /> Fire Department: Post Office: (�,�(�,� School District: c�(2.ont0 <br /> � <br /> Lot Area: Sq.ft. t°I„1�{O Acres •y 3°I Width `C30� Depth <br /> Survey Submitted: Yes_�, No Date of Survey: �'ZZ' �� <br /> Proposed Setbacks: � , <br /> Front (Lake): S y Right Side: � <br /> Rear(Street): 23"J� Left Side: lo • 3Z-� <br /> Adjacent Structures: N l�- Wetland: �1(Ar <br /> Building Height: Def. Hgt. 2,'?� Peak Hgt. 3y` <br /> Lot Coverage: ��ti,,A,,�,�c_ <br /> Grading: Staff Approval Date: 9•2-�i'1 By: � Council Approval Date: s- 2,'7-�i7 <br /> Septic: Staff Approval Date: N 11'� BY: �- <br /> Zoning File: #_�_Z2>ZI Resolution:# 3�03 Resolution Date: 5-Z?-�t7 ' <br /> Shoreland Dis�-ict: V(�5 <br /> Avg. Setback: �1 ARi ar�C�. Bluff Setback: .�/�f� Lot Coverage: JAC1.l�Arrw' <br /> • Existing Proposed <br /> Hazdcover: 0-75' 33.y 2 Z g•b <br /> 75-Z50' . . <br /> ZSO-500' • . <br /> 500-1000' <br /> Hardcover Variaace Required: Yes L No Date of Council Approval: -�� <br /> REMARKS('m house): <br /> 26 <br />