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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> � FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: �r� Sw,•�0 5�-o rv E c�2G(k <br /> PID: <br /> DESCRIPTION OF WORK: /v� /L�� <br /> Z0.�1I�Ti G REY��V BY: DATE A,PPROVED: e - 2�-�y <br /> BUII.Di�i TG REVIEW BY: DATE APPROVED; � -zt�-o�{ <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PER1viIT Yes �/ No <br /> PLAi�t REVIEW Yes v' No SEWER CONNECTION <br /> STATE SURCHARGE Yes � No WAT�CONNEG"ITON <br /> INVESTIGATION FEE � Yes No � PARK FEE <br /> SAC Yes —� No STTEINSPECTION <br /> Number of SAC-Units , 7J OTHER (specify) <br /> ZONING CHE.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: (��9- �`i <br /> Proposed Setbacks: � <br /> Front(Lake): Right Side: � <br /> � � ���� � <br /> Reaz(Street): Left Side: <br /> Adjacent Structures: C7 Netiand: — <br /> Building Height: Def. Hgt. �,(L Peak Hgt. <br /> Lot Coverage: — <br /> Grading: Staff Approval Date: —' By: Council Approval Date: <br /> Septic: Staff Approval Date: '— By: <br /> Zoning File: # — Resolution: !# Resolutioa Date: <br /> Shoreland District: �Jv <br /> Avg. Setback: Bluff Setback: Loc Coverage: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hazdcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS (in house): <br /> 7 <br />