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t . , <br /> �� �� ` <br /> '4 � � CHECK OFF LIST FOR ISSUAI�ICE OF PERMITS <br /> � FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: ��25 �vo2�f s(-/�� �,,e 1 ve <br /> PID: <br /> DESCRIPTION OF WORK: N t�l,c� �S <br /> - ---- -------------- ---------------------------------____ <br /> ZO�'�TG REVIEW BY:��W �y.v�— DATE APPROVED: 1 � -9 S-0 2 <br /> BUII.DI1i 1G REVIEW BY: DATE APPROYED: I o - �S-o Z <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNiIT Yes ✓� No <br /> PLAi�t REVIEW Yes -� No SEWER CONNECTION <br /> STATE SURCHARGE Yes ,/ No WATERCONNECTION <br /> INVESTIGATION FEE Yes No _l� PARK FEE <br /> SAC Yes No �/ SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZONING CH�CK LIST Zoning District: <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. �,y(,Z Acres Width SO Depth / 2�8 <br /> Survey Submitted: Yes pL No Date of Survey: 1-1��Z <br /> Proposed Setbacks: <br /> Fraa�(Lake): �I 5 ' Right Side: (�l� 2 <br /> I�teRr(Street): �5•S' Left Side: S 1 <br /> Adjacent Structures: N//a- �Vetland: N�� <br /> Building Height: Def. Hgt. ZS � Peak Hgt. 2s ' <br /> I.ot Coverage: <br /> Grading: Staff Approval Date: ►U-I>-°Z By: �o• Council Approval Date: -- <br /> Septic: Staff Approval Date: _ �1J(1�- By: <br /> Zoning File: # �2-2g�3 Resolution: # Resolution Date: (b-/y-0 2 <br /> Shoreland District: y�P5 <br /> Avg. Setback: o.t� Bluff Setback: �I//} L.ot Coverage: <br /> Ezistina Proposed <br /> Hardcover: 0-75' � 43 • o <br /> 75-250' S I.6 0 <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes �C No Date of Council Approval: !b -I`�,�'v <br /> REMARKS (in house): <br /> 7 <br />