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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: SZ-1 NOt-i" <br /> PID: <br /> DESCRIPTION OF WORK: <br /> ZONING REVIEW BY: l.Sl — DATE APPROVED: uN <br /> .BUILDING REVIEW BY: DATE APPROVED: <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Yes J No SEWER CONNECTION <br /> STATE SURCHARGE Yes L,--Ilqo WATERCONNECTION <br /> INVESTIGATION FEE Yes 'No PARK FEE <br /> SAC Y.;s No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECK LIST Zoning District: R R`1(3 <br /> Fire Department: Post Office: 16SzATyN School District: 02©N 0 <br /> Lot Area: Sq.ft. IU U c/++ !t!SQ Acres Width Depth <br /> Survey Submitted: Yes No Date of Survey: t=tLF- <br /> Proposed Setbacks: <br /> Front (Lake): 218-7 r t Right Side: 'fS <br /> Rear(Street): '{'tom f. Left Side: 10b 4 <br /> Adjacent Structures: 6J Wetland: 14 0 �= <br /> Building Height: Def. Hgt. 0•K- Peak Hgt. — <br /> Lot Coverage: N (A- <br /> Grading: Staff Approval Date: Al (/} By: Council Approval Date: <br /> Septic: Staff Approval Date: n/1A By: <br /> Zoning File: # I'` A Resolution: # Resolution Date: <br /> Shoreland Disvict: we 5 <br /> Avg. Setback: Bluff Setback: to Lot Coverage: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' 0-K <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No_ Date of Council Approval: <br /> REMARKS(in house): <br /> 26 <br />