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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> AD�RESS OR LEGAL: �9 t�cfl SHn4dJ�n,u od/J Ro� <br /> . <br /> `PID: <br /> DESCRIPTION OF WORK: Gc ,4r�,4r { � iv 7v �,t'� ��r�SA�9 c..Q <br /> ZO.vPtG REVIEW BY: N DATE APPROVED: <br /> BUILDING REVIE`V BY: DATE APPROVED: S -3�• 05- <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes �/ No <br /> PLAN REVIEW � Yes No r/ SEWER CO�TNECTTON <br /> STATE SURCHARGE Yes � No WATERCONNECITON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No � SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZO�TI�TG CH�CK LIST Zoning District: � G[ <br /> Fire Department: Post OfFice: School Disuict: <br /> Lot Area: Sq.ft. Acres Width Depch <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: <br /> Front(Lake): Right Side: <br /> Reaz(Street): Left Side: <br /> Ad;acent Structures: W and: <br /> Building Height: Def. Hgt, eal:Hgt. <br /> Lot Covera�e: <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 /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 2�0-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes N Date of Council Approval: <br /> RE1�iARKS (in house): <br /> � <br />