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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> . FOR OFFICE USE ONLY <br /> ADDRE.SS OR LEGAL: t 43 Z S s l�ti w o oc� �o/ar+r� � <br /> PID: ' <br /> DESCRIPTION OF WORK: Q�Z41,� = (,4,�u� ,C�,,.L,�..orJ <br /> ZO.�tPIi G REVIEW BY: DATE APPROVED: S-7�v -0-3 <br /> BUII..DING REVIEW BY: N �/-� DAT'E APPROVED: <br /> . . c.c-5s ��c sr�o c.�d•� y^,i�j w�fl c..�.�1 M�.�-.�L �./>r <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: � <br /> PER1vIIT Yes r/ No <br /> PLAl�T REVIEW Yes No SEWER CONNECTTOI�' <br /> STATE SURCHARGE Yes No WATERCONNECTION <br /> INVESTIGATION FEE � Yes No PARK FEE <br /> SAC Yes No SITEINSPEC TION <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.ft. Acres � Width Depth <br /> Survey Submitted: Yes_� No Date of Survey: �/`' F�(�tr <br /> Proposed Setbacks: � <br /> Front(Lake): Right Side: (����► / t.�� <br /> . (j�.� A-r ST. <br /> Rear(Street): LeR Side: <br /> Adjacent Structures: Wetland: <br /> Building Height: Def. Hgt. Peal:Hgt. <br /> Lot Coverage: <br /> Grading: Staff Approval Date: S. 20- c�3 By: �c�_ Council Approval Date: � <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # — Resolution: # Resolution Date: <br /> Shoreland Disuict: 4�S <br /> Avg. Setback: .v/� Bluff Setback: N//� Loc Coverage: <br /> Ezistin; Proposed <br /> Hazdcover: 0-75' <br /> 75-250' �v.C , <br /> 250-500' <br /> 500-1000' <br /> Hudcover Variance Required: Yes No_� Date of Council Approval: <br /> REMARI�S(in house)• _ <br /> 7 <br />