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CHECK OFF LIST FOR ISSUAI�TCE OF PERNIITS <br /> FOR OFFICE USE O�'I.Y <br /> ADDRESS OR LEGAL: �S�7 �SAn��s��'e C�2c,l.�- <br /> ' PID: <br /> DESCRIPTION OF WORK: �G�J =� '/,3 0 �c � <br /> ZO.YI�i G REVIEW BY: DATE APPROVED: lu -29 -o� <br /> BiTII.DI�i 1G REV�W BY: DATE APPROVED; /� •2 S •o� <br /> FEES TO BE CHA.RGED: Misc. Fees Ca.lculated By: <br /> PERMIT Yes �/' No <br /> PLAi�t REVIEW Yes v� No SEWER CO��PIECTION <br /> STATE SURCHARGE Yes �/ No �VATERCOI�TI'�TECTION <br /> INVESTIGATION FEE Yes No �� PARK FEE <br /> SAC Yes � No SITEINSPECTION <br /> Number of SAC�Units _� OTHER (specify) <br /> ZONING CH�CK LIST zoning District: . <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes_� No Date of Survey: /D -16`v 3 <br /> Proposed Se[backs: <br /> Front(Lake): J Right Side: c7 <br /> Reaz(Street): � Left Side: � <br /> Adjacent Structures: 0 �Vetland: /� ( /� <br /> Building Height: Def. Hgt. o•1L Peal:Hgt. <br /> Lot Coverage: N � l4 <br /> Grading: Staff Approval Date: 1 0 •Zy- 03 By: `� . Council Approral Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # — Resolution: # Resolu�on Date: <br /> Shoreland District: �J v <br /> Avg. Setback: Bluff Setback: L.ot Co��erage: <br /> Ezisting Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS (in house): �s.�_ �5 � �02 �3��I��n,�, N��5 <br /> 7 <br />