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r <br /> . .�� <br /> CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 3 S S o n�oR TI-f� �'hr0/LE OR 1 � <br /> PID: <br /> DESCRIPTION OF WORK: �q p�,n or�LJ <br /> ZOrZ�TG REVIEW BY: DATE APPROVED: g-ZS -01 <br /> BUII.DING REV�W BY: DATE APPROVED; �g -L 9 •o� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes _� No <br /> PL?u�T REVIEW Yes ,� No SEWER CONNECTION <br /> STATE SURCHARGE Yes r/ No WATERCONNEC'!'ION <br /> INVESTIGATION FEE Yes . No PARK FEE <br /> SAC Yes No STTEINSPECTTON <br /> Number of SAC�Units OTHER (specify) <br /> ZONIl�TG CH�CK LIST Zoning District: �./1-� C <br /> Fire Department: �,dvG(,4iGt� Post Office: L.►�A�r�.�i2�1 School District: 2"t9 <br /> Lot Area: Sq.ft. 2�.J?'-1 Acres -`{�j Width 1 G O Depth Z 3!. z� q`�'� <br /> Survey Submitted: Yes�_ No Date of Survey: �-'�'�� <br /> Proposed Setbacks: <br /> FY'vat(Lake): l 3Z� '!" Right Side: 1 O ' <br /> RAar�(S�ueej:� 9g' � Left Side: �1�' <br /> Adjacent Structures: _�m9�t� Wetland: N ��' <br /> Building Height: Def. Hgt. V�� Peal:Hgt. <br /> Lot Coverage: (2•b`�a <br /> Grading: Staff Approval Date: — By: Council.Approval Date: — <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # Ot�'t(s6l Resolution: # Resolution Date: '3-�2-c�� <br /> Shoreland District: V�S <br /> Avg. Setback: •v�p�� Bluff Setback: nS 1 +� L.ot Coverage: �2•�°?a <br /> E���g Proposed <br /> Hardcover: 0-75' �- �►e c� --,► <br /> 75-250' �{Z �I � , Z <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes OL No Date of Council Approval: 3'��- `n t <br /> REMARKS (in house): _ <br /> 7 <br />