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CHECK OFF LIST FOR ISSUANCE OF PEP-NUTS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 2.'i c8 O OL-0 a c.Ac.t4 <br /> PID: <br /> DESCRIP'T'ION OF WORK: c9 d L- <br /> ZON NG REVIEW BY: DATE APPROVED: I <br /> BUILDING REVIEW BY: DATE APPROVED; to-J -00 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes No <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 /> ZONLVG CHECK LIST Zoning District: ao G/-n4n+�e <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres Width Depth <br /> ,Survey Submitted: Yes_� No Date of Survey: 10-7-A-22— <br /> Proposed <br /> 0.23-2Z- <br /> Proposed Setbacks: <br /> Front(Lake): 2-6 Z Right Side: 'S'0* <br /> Rear(Street): 9 2 Left Side: I1 <br /> Adjacent Structures: 23 4-� G41!►ae_ Wetland: 4J (A <br /> Building Height: Def. Hat. 114 l4 Peak Hgt. <br /> Lot Coverage: /, ' <br /> Grading: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File: # Resolution:# Resolution Date: <br /> Shoreland District: y e5- <br /> Avg. <br /> 5Avg. Setback: ni I Bluff Setback: t/( Loi Coverage: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' 10.2-6 2c� <br /> 500-1000' <br /> Hardcover Variance Required: Yes No 7;!<— Date of Council Approval: <br /> REtiiARKS (in house): <br /> 7 <br />