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, CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> ' FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: Z'1�o P H C�s ANT �� <br /> PID: <br /> DESCRIPTION OF WORK: �q 2/�G� �'�-A(� � �n o� <br /> ZONIl�TG REVIEW BY: DATE APPROVED: y-b �z <br /> BUII..DING REVIEW BY: DATE APPROVED: y. �. o Z-. <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes t/' No <br /> PLAN REVIEW Yes _� No SEWER CONNEC'ITON <br /> STATE SURCHARGE Yes � No WATERCONNECTTON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No STTEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZONING CF�CK LIST Zoning District: <br /> Fire Department: Post Office: School District: � <br /> Lot Area: Sq:ft. 3Z.,Z�iO Acres �7� Width Depth <br /> Survey Submitted: Yes_� No Date of Survey: 3-t Z-o Z <br /> Proposed Setbacks: <br /> F�eat(Lake): l o�` "�' Right Side: 6�� N <br /> Rear(Street): �/�� �' I.eft Side: �{1.2 (S� <br /> Adjacent Structures: (-1'c'�c.t-�-�� Wetland: N �� <br /> Building Height: Def. Hgt. �,.� Peal:Hgt. A.f� <br /> Lot Coverage: `� �o <br /> Grading: Staff Approval Date: /✓ (� By: Council Approval Date: <br /> Septic: Staff Approval Date: �(/� By: <br /> Zoning File: # Resolution: # — Resotution Date: <br /> Shoreland District: y2S <br /> Avg. Setback: o,t� Bluff Setback: ,�l f/f LotCoverage: <br /> Existing Proposed <br /> Hazdcover: 0-75' � <br /> '75-250' Z Y.�� <br /> 250-500' D <br /> 500-1000' <br /> Hardcover Variance Required: Yes No_� Date of Council Approval: <br /> REMARKS(in house): <br /> 7 <br />