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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 1 343 02-0 iv(D LA ti <br /> PID: <br /> DESCRIPTION OF WORK: PA-no <br /> ZONING REVIEW BY: cilL �•-- DATE APPROVED: 'f - 3 - y <br /> BUILDING REVIEW BY: Air DATE APPROVED: S - 3 'i k <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 WATER CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECK LIST Zoning District: `Q <br /> Fire Department: wTAT" Post Office: w+4y-u4-rY4- School District: 011-,=A-,0 <br /> Lot Area: Sq.ft. 5`2), `-{0 Acres 1 - Z . Width /lZ(t(;7oUC.4ADepth <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: <br /> Front (Lake): 4101 Right Side: N(A <br /> Rear (Street): N(t4 Left Side: <br /> Adjacent Structures: W.-n-t4rt S Wetland: Ai 1p <br /> Building Height: Def. Hgt. R- Peak Hgt. N (A- <br /> Lot <br /> A- <br /> Lot Coverage: 6 '{ <br /> Grading: Staff Approval Date: Ai IA- By: — Council Approval Date: <br /> Septic: Staff Approval Date: ,d(4 By: <br /> Zoning File: # 2 133 Resolution: # Resolution Date: 4E,- 10- Cr t, <br /> Shoreland District: Y' <br /> Avg. Setback: NIA- Bluff Setback: N IA <br /> Existing Proposed <br /> Hardcover: 0-75' r 7.0 /s $ <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes — No Date of Council Approval: 1.-10-9 G <br /> REMARKS (in house): <br /> 10 <br />