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• � CHECK OFF LIST FOR ISSUANCE OF PERNIITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: __ Zs no �N�4ip�c�ro o,A <br /> PID: <br /> DESCR�'I'IONOFti�ORK: �N-c�R,�p� �'?��rvt.c,/�.ec� <br /> ZO�tING REV�W BY: N(i4 DATE APPROVED: <br /> BUII�DING REVIEW BY: � DATE APPROVED: g- Zg.g g <br /> FEES TO BE C�IARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Yes �/' No SEWER C0�INECTION <br /> STATE SUR:�iARG� Yes �/ No WATERCONNECTION <br /> INVESTIGAZ'ION FEE Yes No PARK FEE <br /> SAC Y.;s No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONPi TG CHECK LIST Zoning District: rJ /`/� � u�N�/�'' <br /> /l/ �� i � v <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: <br /> Front (Lake): _ Right Side: <br /> Rear (Street): Left Side: <br /> Adjacent Structures: Wetland: <br /> Building Height: Def. Hgt. Peak 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 Dis�ict: <br /> Avg. Setback: Bluff Setback: L.o[Coverage: <br /> • Eziscing Proposed <br /> Hardcover: 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): <br /> • 26 <br />