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, , , <br /> CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: (�S 3 5A/V��/U�_ ('�2��--r � <br /> PID: <br /> DESCRIP'I'ION OF WORK: /ti1�w /2�-3 <br /> ZO�tPi 1G REVIEW BY: DATE APPROV�D: q -�-a� <br /> BUII�DING REV�`�BY: DATE APPROVED: �- � -�� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PER11iIIT Yes �/ No <br /> pL,Al�i REVIEW Yes i/ No SEWER CONNEC'ITO�i <br /> STATE SURCHARGE Yes _�/ No WATERCONNECI'ION <br /> INVESTIGATION FEE � Yes No � PARK FEE <br /> SAC Yes _� No SITEINSPECTION <br /> Number of SAC�Units y OTHER (specify) <br /> ZO�Ti�tG CHE.CK LIST Zoning District: -. <br /> Fire Department: Post Office: School District: � <br /> Lot Area: Sq.ft. Acres � Width Depth <br /> Survey Submitted: Yes_ c� No Date of Survey: �Y-3• �3 <br /> Proposed Setbacks: <br /> Front(Lake): ['� Right Side: � <br /> Rear (Street): � Left Side: � <br /> Adjacent Structures: (� �Vetland: /�l ��4 <br /> Building Hei�h[: Def. Hgt. �, �� Pealc Hgt. <br /> Lot Coverage: /l� ({'4 <br /> Grading: Staff Approval Date: CJ•�� By: Council Approval Date: <br /> Septic: Staff Approval Date: /�( (/a- By: <br /> Zoning File: # Resolution: # Resolution Date: <br /> Shoreland District: � V <br /> Avg. Setback: Bluff Setback: I.oc Cover�e: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council App:oval: <br /> R.ENIARKS (in house): � C�.�! �5�4��5'T�� C �2u'� . � f v��� <br /> � . . <br />