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. � <br /> CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> A.DDRESS OR LEGAL: /g 3S SHA�OyW000 2e� <br /> PID: � <br /> DESCRIP'i'ION OF WORK: D�GI� <br /> ZO�YG REVIE`V BY: DAT'E APPROVED: 9-34-a�l <br /> BUII�DI�IG REVIE`V BY: DATE APPROVED; 9• 30-o� <br /> FEES TO SE CHARGED: Misc. Fees Calculated By: <br /> PERNiIT Yes ✓ No <br /> PLA��t REVIEW Yes _�' No SEWER CONNEC"ITON <br /> STATE SURCHARGE Yes �/ No WATIItCONNEC"I'ION <br /> INVESTIGATION FEE • Yes No PARK FEE <br /> SAC Yes No STTEINSPECTTON <br /> Number of SAC�Units OTHER (specify) <br /> ZOYI�IG CH�CK LIST Zoning Districr. G/�-/G . <br /> Fire Department: Post Office: School District: • <br /> Loc Area: Sq.ft. Zy�Z�Z Acres 7S � Width Depth <br /> Survey Submitted: Yes x No Date of Survey: p�r F�� 8-2�-g9 <br /> Proposed Setbacks: <br /> Froat(Lake): `�� � Right Side: Z� � <br /> Rear (Street): t'�5 � Left Side: y b� <br /> Adjacent Structures: � � � s�j Netland: � . <br /> Building Hei;ht: Def. Hgt. — Pea:l:Hgt. ' <br /> L.ot Coveraae: " °+'•� <br /> Gradina: Scaff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: — BY: <br /> Zoning File: # o3•2�i3S Resolution: # Resolution Date: /I•LY- e3 <br /> 3horeland District: <br /> Avg. Setbac : �,�ari.�+�..re� Bluff S��7 — I.otCovera;e: — <br /> Eusting Proposed <br /> Hazdcover: 0-75' t� � . <br /> 75-250' Z,'g <br /> 250-500' <br /> 500-100Q' <br /> Hazdcover Variance Required: Yes No Date of Council Approval: <br /> REI�ZARKS (in house): <br /> 7 <br />