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- CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> A.DDRESS OR LEGAL: �/Z o3 �va��i s yo.ar. ,orz. <br /> PID: <br /> DESCRIPTIO�T OF WORK: NFc� rr�-� <br /> ZO�TG REV�W BY: , DATE APPROVED: 9 ZZ-�s� <br /> BUILDIlVG REVIEW BY: DATE APPROVED: g-zz-a� <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 v PARK FEE <br /> SAC Yes No _,� SITEINSPECTTON <br /> Number of SAC�Units ��F,,�,,,�`� �,.,,,�,�,,- ft OTHER (specify) <br /> --�� � �____________??�_52!:�1_w�___________w_______�_�__. <br /> ZONI�TG CHE.C$ LIST Zoning Districr. G2-/� <br /> Fire Department: Post Office; School District: � <br /> Lot Area: Sa.ft. yS,74b Acres �•�5 � Width S�Sf�'��O`"'Q Depth <br /> Survey Submitted: Yes � No Date of Survey: "7-�S- o S <br /> Proposed Setbacks: � <br /> Front(Lake): 1 l�i' Right Side: 2�.�' <br /> Rear(Street): Z�S� Left Side: �i•� <br /> Adjacent Structures: N 1 q Wetland: N /�' <br /> Building Heibht: Def. Hgt. 2'B•? Peal;.Hgt. 35� <br /> Lot Coveraoe: 7`�a <br /> Gradi.ng: Staff Approval Date: //-�, u 5 By:�.O, f�KCouncil Approval Date: '— <br /> Septic: Staff Approval Date: N 1�1 By: - <br /> Zoning File: # o • 1 Resolution: # Resolution Date: 4- 1 Z-�S <br /> Shoreland District: y t S <br /> Avg. Setback c�.tc. Bluff Setback: N/A Lot Coverage: 7°?a <br /> Existing Proposed <br /> Hardcover: 0-75' a°?a <br /> 75-250' 22.(o'le <br /> 2�0-500' �.� °7� <br /> 500-1000' <br /> Hardcover Variance Required: Yes No� Date of Council Approval: <br /> REEIi�1ARKS (in house�: <br /> 7 <br />