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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: (0 6-7 �Si��Sre N� c,_rZ <br /> PID: <br /> DESCRIPTION OF WORK: nJ�} /Lc3 �/3 o F 3 (�c,c� : <br /> Z0�1I�i TG REV�W BY: DATE APPROVED: �/- z3 -o s- <br /> BUII.DIti G REVIEW BY: DATE APPROVED: ��. z 3-o f <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 WATER CONNECTTON <br /> INVESTIGATION FEE Yes No ✓ PARK FEE <br /> SAC Yes � No STTEINSPECTTON <br /> Number of SAC�Units �. OTHER (specify) <br /> ZO�iIVG CH�CK LIST zoning Districc: <br /> Fire Department: Post Office: School District: <br /> I.ot Area: Sc.ft. Acres Width Depth <br /> Survey Submitted: Yes� No Date of Survey: �o -►�{,-b� <br /> Proposed Setbacks: <br /> Front(Lake): O Right Side: d <br /> Rear(Street): � Left Side: � <br /> Adjacent Structures: U Wetland: /V/�9 <br /> Building Height: Def. Hgt. 0,Ic. Peal:Hgt. <br /> Lot Coverage: �v I,�- <br /> Grading: Staff Approval Date: ^!/y�} By: Council Approval Date: <br /> Septic: Staff Approval Date: �/ �/� By: <br /> Zoning File: # Resolution: # Resolution Date: <br /> Shoreland District: �/(� <br /> Av�. Setback: Bluff Setback: I.ot Coverage: <br /> Ezistin� Proposed <br /> b <br /> Hardcover: 0-75' <br /> 7�-250' <br /> 2�0-500' <br /> 500-1000' <br /> Hardcover Vaziance Required: Yes No Da[e of Council Approval: <br /> REI�IARKS (in house): <br /> 7 <br />