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� <br /> � CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> , FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: y H S 5 /V O R'h� �I�t-d�?�, Q R . <br /> PID: <br /> DESCRIPTION OF WORK: ��Ejnq(,�s <br /> ZONING REV�W BY: DATE APPROVED: <br /> BUII�DING REV�W BY: DATE APPROVED: <br /> FEES TO BE CIiARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓' No <br /> PLAN REVIEW Yes ✓' No SEWER CONNECTION <br /> STATE SURCHARGE Yes �,G No WATERCONNEC'TTON <br /> INVESTIGATION FEE Yes Nb , PARK FEE <br /> SAC Yes No � SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECB LIST Zoning District: !.R- �Q � <br /> Fire Department: �'�/(,��,�,�/) Post OfFice: MN��.+�p School District: wt�r-vN�p� <br /> Lot Area: Sq.ft. Z'�. (�.�v Acres .`Z Width �i.�, u v4�n Depth <br /> Survey Submitted: Yes� No Date of Survey: I I-1 L��l'7 <br /> Proposed Setbacks: <br /> Front(Lake): 215� '} Right Side: L 0 <br /> Reaz(Sueet): f 5 � = Left Side: s• <br /> Adjacent Structures: �� Wetland: /�J��¢ <br /> Building Height: Def. Hgt. /2� Peak Hgt. / (s� <br /> Lot Coverage: -- <br /> Grading: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # 'L� Resolution: # 32Z Resolution Date: 7-Z�, •9�j <br /> Shoreland District: �� <br /> Avg. Setback: p.�C Bluff Setback: Itl.�y, LotCoverage: — <br /> Facisting Proposed <br /> Hazdcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS(in house): <br /> 7 <br />