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� • CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 2�1 b O �f1 N O�o n!� C.A N c: � <br /> PID: <br /> DESCRIPT'ION OF WORK: ot/c�v � <br /> ZO.�Pi 1G RE'VIE�V BY: DAT�APPROVED: 9- >-G3 <br /> BUII.,DING REVIEtiV BY: DATE APPROVED: r- �= a 3 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PER►tiiIT Yes � No <br /> pLAl�i REVIEW Yes _� No SEWER CONNECIZON <br /> STATE SURCHARGE Yes _� No WATERCOivNECi'ION <br /> INVESTIGATION FEE � Yes No PARK FEE <br /> SAC Yes � No SIT'EINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZONIti'G CH�CK LIST Zoning District: . <br /> Fire Department: Post Office: School District: • <br /> Lot Area: Sq.ft. Acres � Width Depth <br /> Survey Submitted: Yes /r No Date of Survey: cl� 3-�3 <br /> Proposed Setbacks: � <br /> Front(Lake): d Right Side: O <br /> Reaz(Street): 1 Z- Left Side: p <br /> Adjacent Structures: b �Vetland: i✓�/� <br /> Building Height: Def. Hgt. o .(�- Peal:Hgt. <br /> Lot Covera�e: /U (�- <br /> Grading: Staff Approval Date: �/C By: Council Approval Date: <br /> Septic: Staff Approval Date: ���- By: <br /> Zoning File: # — Resolution: � Resolution Date: <br /> Shoreland Distric[: /�� <br /> Avg. Setback: Bluff Setback: I,ot Cover�e: <br /> Ezistin� Proposed <br /> 0 <br /> Hardcover: 0-75' <br /> 7�-250' <br /> 250-500' <br /> 500-1000' <br /> Hazdcover Variance Required: Yes No Date of Council App:oval: <br /> RE1�ZA,RKS (in house): �� <br /> 7 . � <br />