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� � <br /> CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: y o5 c�'K�'oc=.�p tz�o A✓� <br /> PID: <br /> DESCRIPTION OF WORK: �,�� � � o� -rw� c�., <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING REVIEW BY: DATE APPROVED: 7 _�»�o <br /> BUILDING REVIEW BY: DATE APPROVED: 7�zo-�o <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 /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING CHECK LIST Zoning District: (,Q-/f} <br /> Fire Department: Lp�v6 �ilK.�£' Post Office: (�e�, (�Irtt School District: Q�L.�jNO <br /> Lot Area: Sq.ft. �t/�o G�/-�,erc,Q Acres r-- Width -r Depth ""' <br /> Survey Submitted: Yes J� No Date of Survey: g-2'7. $3 <br /> Proposed Setbacks: � <br /> Front (Lake): Z�� �" Right Side: $a '�. <br /> Rear(Street): 2. 3o f � Left Side: �pp � '}' <br /> AdjacentStructures: p�-T*�ya,,G�-}�� Wetland: /li ((Pr <br /> Building Height: Def. Hgt. �, (�. Peak Hgt. — <br /> Lot Coverage: N � � <br /> Grading: Staff Approval Date: '1-?,p_ t�J By: d-0 . Council Approval Date: <br /> Septic: Staff Approval Date: -^ By: <br /> Zoning File: # — Resolution: # Resolution Date: <br /> Shoreland District: v�S <br /> Avg. Setback: c�.1,c Bluff Setback: /�! (iA- L,ot Coverage: ^///� <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' d� 1� <br /> 250-500' � <br /> 500-1000' <br /> Hardcover Variance Required: Yes No_� Date of Council Approval: <br /> REMARKS (in house): �}�,� o„-r M.G .(�v. � . ���.w� �� ll.c4. s/,�-�;�7'— <br /> 7 <br />