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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> ' FOR OFFICE USE ONLY <br /> - ADDRESS OR LEGAL: I b75 S��y t.v��A lLe�,4D <br /> PID: <br /> DESCRIPTION OF WORK: t,v„VO�✓ inls�wA��� <br /> Z0.�1Ivi G REV��V BY: G�/�iQ DATE APPROVED: <br /> BLTII�DI�i'G REVIE`V BY��-_�NN�---------------DATE APPROVED---l,_23-�6------ <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes �/ No <br /> PLAN REVIEW � Yes No �/ SEWER CONNECTION <br /> STATE SURCHARGE Yes __� No WATER CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No � STTEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZOi�TI�TG CH�CK LIST Zoning Districr. w o G�Q <br /> Fire Department: Post O�ce: School District: <br /> Lot Area: Sc.ft. Acres Width Depch <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: <br /> Front (Lake): Right Si . <br /> Rear(Street): Left S' e: <br /> Adjacent Structures: Wetland: <br /> Building Height: Def. Hgt. Peal:Hgt. <br /> Lot Coverage: <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File: # Resolution: # Resolution Date: <br /> Shoreland District: <br /> Av?. Setback: Bluff Set ack: L.ot Coverage: <br /> Existing Proposed <br /> Hardcover: 0-7�' <br /> 7�-250' <br /> 2�0-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Da�e of Council Approval: <br /> RE�KS (in house): -- <br /> 7 <br />