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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> , FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: I �6 O S H.4�t�t�o 0�0 � <br /> PID: � <br /> DFSCRIPTION OF WORK: �LZ{c t3x D.9•�sco N <br /> ZO.�tI�i TG REVIEW BY: DATE APPROVED: �,/-�y-a3 <br /> BUII.,DING REVIEW BY: DATE APPROVID; Y-��/-a 3 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes �� No <br /> PLAi�T REVIEW �es �/ No SEVYER CONNEC'IION <br /> STATE SURCHARGE Yes _�� No WATF.R CONNECTTON <br /> INVESTIGATION FEE � Yes No PARK FEE <br /> SAC Yes No 3TTEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZONING CH�CK LIST Zoning District: N o C�w�e <br /> Fire Department: Post Office: School District: � <br /> Lot Area: Sq.ft. Acres � idth Depth <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: ' � <br /> Front(Lake): Right Side: <br /> Reaz(Street): Left Side: <br /> Adjacent Structures: Wetlan : <br /> Building Height: Def. Hgt. Peal:H t. <br /> L.ot 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 /> Avg. Setback: Bluff Setback: L.ot Coverage: <br /> Eusting Proposed <br /> Hazdcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS (in house): �'� p�lo ADo�.�,•� � G x,sn^�l oL� - o�-�. r_=���%�•�5 <br /> /�b9ll.rJ Gaw<-� - �Ilo Zo�•«n � s s�.�-e s <br /> 7 <br />