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, CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> • FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 3ti G o N o Rn-t s/�o/1,� �2 i V� <br /> PID: <br /> DESCRIPTION OF WORK: ���� <br /> ZONING REVIEW BY: DATE APPROVED: //•�S- o Z <br /> BUILDING REVIEW BY: DATE APPROVED; �I-� 'S' •o-Z, <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes � �/, ' No <br /> PLAN REVIEW Yes ✓ No SEWER CONNECTTON <br /> STATE SURCHARGE Yes �./No WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZONING CHE.CK LIST zoning Districc: . <br /> Fire Department: Post Office: School District: � <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes,�_ No Date of Survey: <br /> Proposed Setbacks: <br /> �roet(Lake): 1 V y' -+—' Right Side: 7. S <br /> R�r(Street): t p� Left Side: I 2•2 <br /> Adjacent Structures: Arrwc�� Wetland: N�r4 <br /> Building Height: Def. Hgt. Peal:Hgt. — <br /> Lot Coverage: 22•1 <br /> Grading: Staff Approval Date: ^ By: — Council Approval Date: — <br /> Septic: Staff Approval Date: — By: ^ <br /> Zoni.ng File: # 0 2-zg 2 3 Resolution: # Resolution Date: �I• �2 -n 2 <br /> Shoreland District: v.Q s <br /> Avg. Setback vA2,w..,� Bluff Setback: N 1 l� Lot Co��Be� ZZ•1 <br /> Existing Proposed <br /> Hardcover: 0-75' T.rv.R• <br /> 75-250' 43 �`a <br /> zsasoo� <br /> soo-iaoo� <br /> Hardcover Variance Required: Yes_� No Date of Council Approval: ((- �Z • o'Z. <br /> REMARI�S(in house): <br /> 7 <br />