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� CHECK OFF i,IST FOR ISSUANCE OF �ERMITS <br /> • FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: Z s�o ,5i�,�s-ron•e, �,�.e <br /> PID: <br /> DESCRIPTION OF WORK: NP� �-� <br /> ZO�tPi 1G REV�W BY: DATE APPROVED: 2 -t3- ub <br /> BUII.DING REVIEW BY: DATE APPROVED; Z. ►�-a� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW � Yes � No SEWF.R CONNEC"I'ION <br /> STATE SURCHARGE Yes ✓ No WATERCONNECTION <br /> INVESTIGATION FEE Yes No —� PE1RK FEE <br /> SAC Yes 8c No � STTEINSPECTION <br /> Number of SAC�Units �- OTHER (specify) <br /> ZO�TING CH�CK LIST Zoning District: <br /> Fire Department: Post O�ce: School District: <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes�_ No Date of Survey: �- 0 3 •o� <br /> Proposed Setbacks: � <br /> Front(Lake): 'O Right Side: � <br /> Rear(Street): I 1� Left Side: a <br /> Adjacent Structures: C) Wetland: D.I� <br /> Building Height: Def. Hgt. (� . (� Peal:Hgt. — <br /> Lot Covera;e: N (rq <br /> Grading: Staff Approval Date: � By: Council Approval Date: � <br /> Septic: Staff Approval Date: By: <br /> Zoning File: # — Resolution: # Resolution Date: <br /> Shoreland District: /V(� <br /> Avg. Setback: Bluff Setback: L.ot Coverage: <br /> Eusting Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 2�0-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REviA.RKS (in house): <br /> 7 <br />