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, , • �.- , , . <br /> CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 2�Sa o �4 3�N G O o� w A y <br /> PID: <br /> DESCRIP'I'ION OF WORK: _��,.G2.,� �. C3A-n-� �2c�—w•�c�e� <br /> Z0�1I�TG REV�W BY: „` DATE APPROVED: �• ? -�/-o S <br /> BUII.DING REVIEW BY: DATE APPROVED: '7•�1� d S <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓' No <br /> PLAN REVIEW � Yes ✓' No SEV�ER CONNECTION <br /> STATE SURCHARGE Yes � No WATERCONNECTTON <br /> INVESTIGATION FEE Yes • No �� PARK FEE <br /> SAC Yes No _� SITEINSPEC"ITON <br /> Number of SAC�Units OTHER (specify) <br /> ZONING CH�CK LIST Zoning District: /V� G !.f AN(�P <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: <br /> Front(Lake): Right Sid <br /> Rear(Sueet): Left Si : <br /> Adjacent Structures: Wetland: <br /> Building Height: Def. Hgt. eak 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: <br /> Avg. Setback: Bluff Se back: L.otCoverage: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hudcover Variance Required: Yes No Date of Council Approval: <br /> REMARI�S(in house): <br /> 7 <br />