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m <br /> CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: Z9 Z 5 C>t—N:!, t3`lAc-14 20.4,Q <br /> PID: <br /> DESCRIPTION OF WORK: M EW R-C-S <br /> ZONING REVIEW BY: DATE APPROVED: 5 -2.y-C1 1. <br /> BUILDING REVIEW BY: DATE APPROVED: 5-24- 4 SA <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> pERNHT Yes ✓ No <br /> PLAN REVIEW Yes ✓ No SEWER CONNECTION <br /> STATE SURCHARGE Yes No WATER CONNECTION <br /> INVESTIGATION FEE Yes No ✓ PARK FEE <br /> SAC Yes —� No SITE INSPECTION <br /> Number of SAC Units 1 OTHER (specify) <br /> ZONING CHECK LIST Zoning District: LR-AG Shoreland District: ye S <br /> Fire Department: Mo un►e.,)- Post Office: w A�j-yyy% School District: ts,,s @s-rnNi4A <br /> Lot Area: Sq.ft. E3fd, 25Q1 Acres 2 • Width 23b Awle Depth 37`j A d <br /> Survey Submitted: Yes y_ No Date of Survey: .g' -!-9 fo <br /> Proposed Setbacks: <br /> Front (Lake): 35. Right Side: 12s; ' S <br /> Rear (Sara*): ZS6 Left Side: 'q/ <br /> Adjacent Structures: NIA Wetland: <br /> Building Height: Def. Hgt. A Peak Hgt• 3c� <br /> Avg. Setback: N 14 Bluff Setback: N/µ Lot Coverage: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No_X_ Date of Council Approval: <br /> Grading: Staff Approval Date: 5-21-`j G- By: . V Council Approval Date: N�iEJ <br /> Septic: Staff Approval Date: AI/A By: <br /> Zoning File: # Resolution: # Resolution Date: _ <br /> REMARKS (in house): <br /> 26 <br />