Laserfiche WebLink
CHECK OFF i,IST FOR iSSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: Z53+� �ln�osZ-or�,� c.�� <br /> PID: <br /> � DESCRIPTION OF WORK: ti� (Zk 3 <br /> ZO�.�tI�ti G RE'VIEW BY: DATE APPROVED: L-�3-a` <br /> BUILDING REVIE`V BY: DATE APPROVED; 2.�3-�� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes � No <br /> PLAN REVIEW � Yes � No SEWF�R CONNECTION <br /> STATE SURCHARGE Yes J No WATERCONNECTION <br /> INVESTIGATION FEE Yes • No� �v PARK FEE <br /> SAC Yes �/ No _� STTEINSPECTION <br /> Number of SAC�Units 2 OTHER (specify) <br /> Z011It�IG CH�CK LIST Zoaing Districr. <br /> Fire Department: Post Office: School District: � <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes_�, No Date of Survey: I-30-c�6 <br /> Proposed Setbacks: � <br /> Front(Lake): 3�� Right Side: � <br /> Rear (Street): D Left Side: � <br /> Adjacent Structures: t� Wetland: p'r s.Q�'►'3�K-K <br /> Building Hei�t: Def. Hgt. � .lc Peal:Hgt. — <br /> Lot Coveraoe: N �� <br /> Grading: Staff Approval Date: — By: Council Approval Date: � <br /> Septic: Staff Approval Date: � By: <br /> Zoning File: # — Resolution: # Resolution Date: <br /> Shoreland District: /�Iv <br /> Av�. Setback: Bluff Setback: I.ot Coverage: <br /> Eustmg Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> : REviARKS (in house): <br /> � <br />