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• CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: �f N S� N'aR T7f �/�0�2�= �pQi V c_. <br /> PID• ,�� -� . ,� 7 � ,} 3 � � oc�o a-- <br /> DESCRIPTION OF WORK: ��c <br /> ------------------------------------�------- --------------------------------------------------�------�----_---�-- <br /> ZONING REVIEW BY: � DATE APPROVED• ( � l Z S <br /> BUILDING REVIEW BY: DATE APPROVED: � � - i z -i� <br /> '� ��" FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> ;�'` PERMIT Yes ,/ No <br /> r, . <br /> � PLAN REVIEW Yes No SEWER CONNECTION <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 /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING CHECK LIST Zoning District: L2- //3 <br /> Fire Department: M�u�nr,p Post Office: ✓VW�N � School District: v.r e s r o�..i i� <br /> Lot Area: Sq.ft. 2'7�C�c�p Acres •`Z Width ��Z2.L�u�� Depth <br /> Survey Submitted: Yes X No Date of Survey: I t� I Z- �i �1 <br /> Proposed Setbacks: <br /> �t(Lake): (�Q� Right Side: ( 3.3 <br /> � � t <br /> P�ea� (Street): q5 Left Side: 35 <br /> Adjacent Structures: A�'���-t-C� Wetland: /V(A <br /> Building Height: Def. Hgt. /�f 1 v� Peal:Hgt. -' <br /> Lot Coverage: Ic�.'1 <br /> Grading: Staff Approval Date: �( (/� By: — Council Approval Date: — <br /> Septic: Staff Approval Date: N( I(k By: — <br /> Zoning File: �# 2y Z� Resolution: # Resolution Date: !( - °I•5`� <br /> Shoreland District: <br /> Avo. Setback: VA2►✓�NC:� Bluff Setback: /J /(� LotCoverage: (4.� <br /> � Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' 3 Z �`► ���. j <br /> 500-1000' <br /> Hardcover Variance Required: Yes�_ No Date of Council Approval: <br /> REMARKS (in house): <br /> 7 <br />