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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 1120 012C.I-/ARh 'NIX. Al <br /> PID: <br /> DESCRIPTION OF WORK: I Fc. <br /> ZONINGREVIEPVBY: cSDATE APPROVED: 3 4-y -o <br /> BUILDING REVIEW BY: is. DATE APPROVED: 'f-`-f-o s <br /> FEES TO BE CHARGED: Mise. Fees Calculated By: <br /> PERMIT Yes 17 No <br /> PLAN REVIEW Yes t/ No SEWER CONNECTION <br /> STATE SURCHARGE Yes l/ No WATER CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITE INSPECTION <br /> • <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECK LIST Zoning District: <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. y•35— Acres lel::X66 Width Depth <br /> Survey Submitted: Yes�C No Date of Survey: 4-4.- 02 otk► F t4s <br /> Proposed Setbacks: , <br /> s1 <br /> Front(Lake): /O•t Right Side: 132 N <br /> Rear(Street): 161. ± Left Side: I4 S l s <br /> Adjacent Structures: — Wetland: — <br /> Building Height: Def Hgt. — 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: N <br /> Avg.Setback: Bluff Setback: Lot Coverage: <br /> Existing Proposed <br /> Hardcover: 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 /> 31 <br /> • <br />