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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 2c�$o s�4c..�n� Ca,�,c��- <br /> PID: <br /> DESCRIPTION OF WORK: �< � rr.�t�,–►v r G3�4T��F 12.C^v�-�a ryt L. <br /> --____-----_------- __.___ ------------------------------------------------------------ <br /> ZO�.�lYi G RE'VIEW BY: DATE APPROVED: g-i 2 -oS <br /> BUII�DII�G REVIE`V BY: DATE APPROVED: 5.�2-0�-1— <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 WATERCONNECI'ION <br /> INVESTIGATION FEE Yes No � PARK FEE <br /> SAC Yes No �i/ SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZONING CEi�CK LIST Zoning District: wo Gf� <br /> Fire Department: Post O�ce: School District: <br /> Lot Area: Sc.ft. Acres idth Depch <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: <br /> Front(Lake): Righ ide: <br /> Rear(Street): Left ide: <br /> Adjacent Structures: etland: <br /> Building Height: Def. Hgt. P ' Hgt• <br /> Lot Coverage: <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: y: <br /> Zoning File: # Resolution: # Resolution Date: <br /> Shoreland District: <br /> Avg. Setback: Bluff Setback: Lot Coverage: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 2�0-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REI�IARKS (in house): <br />