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f . � � <br /> , ' <br /> CHECK OFF LIST �R ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: ZSnv St-thA�Jv W o oro t2��A0 <br /> PID: i <br /> DESCRIPTION OF WORK: p F��c,.c:, ,z,�;,v►��„o�� <br /> ----------------------------------------------____------------------------------------------------------------------ <br /> ZONING REVIEW BY: N ( IA DATE APPROVED: <br /> BUILDING REVIEW BY: DATE APPROVED: �- 6 •c�� <br /> ------------ -------------------------- -------�---------------------------------------------------------------- <br /> FEES TO BE CHARGED: �Misc. Fees Calculated By: <br /> PERMIT Yes �✓ I No <br /> PLAN REVIEW Yes � �iNo SEWER CONNECTTON <br /> STATE SURCHARGE Yes � ��No WATERCONNECTION <br /> INVESTIGATION FEE Yes �No PARK FEE <br /> SAC Yes �To ' � SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> Z0�1ING CHECK LIST Zoning District: G C: <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: �i <br /> Front(Lake): Right Sid�: <br /> Reaz (Street): Left Side: <br /> Adjacent Structures: etl d: <br /> Building Height: Def. Hgt. P ak gt. <br /> Lot Coverage: �� <br /> Grading: Staff Approval Date: � By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File: # Resolution: # esolution Date: <br /> Shoreland District: <br /> Avg. Setback: Bluff Setb k: Lot Coverage: <br /> Existing Proposed <br /> Hazdcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes Np Date of Council Approval: <br />� REMARKS (in house): <br /> 1� 1 <br />