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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> �ADDRESS OR LEGAL: 2�f 7(� .s�'A/�,rJS7�'DI�/L. L Arv� . <br /> , PID• <br /> DESCRIPTIOv OF WORK: /V� =S . li o F -r—o�,.��t+or��:. <br /> ZO�TPi tG REV�W BY: DATE APPROVED: �o-z�-�3 <br /> BUII.DING REVIEW BY: DATE APPROVID: �o- z�-0 3 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes _� No <br /> PLAN REVIE� Yes �' No SEWER CONNECTION <br /> STATE SURCHARGE Yes _� No WATERCONNECTION <br /> IIWESTIGATION FEE � Yes No PARK FEE <br /> SAC Yes �c No STTEINSPECTTON <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.fr. Acres � Width Depth <br /> Survey Submitted: Yes_� No Date of Survey: ��- �b•n3 <br /> Proposed Setbacks: � <br /> Front(Lake): O Right Side: d <br /> Rear(Street): � Left Side: 1� <br /> Adjaceni Siructures: O Wetl�d: YL� <br /> Building Height: Def. Hgt. Pea�Hgt. <br /> Lot Coveraae: ��� <br /> Grading: Staff Approval Date: B;-: Council Approval Date: <br /> Septic: Staff Approval Date: �(� B3•: <br /> Zoning File: � -- Resoludon: # Resolution Date: <br /> Shoreland District: /U� <br /> Avg. Setback: Bluff Setback: L,ot Coverage: <br /> g��g Proposed <br /> Hazdcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hazdcover Variance Required: Yes No Date of Council Approval: <br /> REI�ZARKS ('in house): sa� P�,•� �,2 2Y�� s�05�•� �.�� <br /> 7 <br />