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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: Th-4 0 0ca.c 1- M O �Q,p�,�lc (L1 <br /> PID: <br /> DESCRIPTION OF WORK: Po u:. r3 w ,.► <br /> ZONING REVIEW BY: cp 5 DATE APPROVED: ? •22 -o� <br /> BUILDING REVIEW BY: DATE APPROVED: 8 -2.2 -0/ <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes (7' No <br /> PLAN REVIEW Yes v No SEWER CONNECTION <br /> STATE SURCHARGE Yes v No WATER CONNECTION <br /> INVESTIGATION FEE Yes No v. PARK FEE <br /> SAC Yes No '� SITEINSPECTION <br /> Number of SAC�Units _ OTHER (specify) <br /> ZONING CHECK LIST Zoning District: R 2-I A <br /> Fire Department: M t\Pt�: QtA,rJ Post Office: (pv (A 14,e School District: O rl o N <br /> Lot Area: Sq.ft. Acres '-1.6 Width /64,10Z(A.474. Depth <br /> Survey Submitted: Yes al. No Date of Survey: (v-Zt ' 2-440o <br /> Proposed Setbacks: <br /> Front(Lake): 1 o 3.3 Right Side: 2.32' f <br /> Rear (Street): 14,5 Left Side: 39 t,' <br /> Adjacent Structures: LI S Wetland: .} <br /> Building Height: Def. Hgt. ,2 01 Peak Hgt. 2.4/ O K AN' <br /> r � <br /> ( t) Assuwu.d hci gtit' no hilve- <br /> Lot Coverage: N//4- ♦hah pt0.k 0-14 0-6 <br /> Grading: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File: # Z`0 u Resolution: # 11$75'j Resolution Date: IF (9' 0 0 <br /> Shoreland District: A/0 <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 /> 7 <br />