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� � CHECK OFF LIS FOR ISSUANCE OF PERII�IITS <br /> _ FOR OFFICE USE ONLY � <br /> ADDRESS OR LEGAL: 2 v � <br /> PID: <br /> DESCRIP'IZON OF WORK: �q.;�,���- s,� S ;z� - <br /> . - <br /> ZO�i'G REY�`Y BY: ' DATE APPROVED: <br /> BUII.DI�i iG REV�tiV BY: , (( j (A'`4.�.��. DATE APPROVED; c�-1 ci �v <br /> � <br /> FEES TO BE CA.ARGED: Misc. Fees Calculated By: <br /> pERMIT Yes � No : <br /> PLAN REVIEW Yes ✓ No SEWER CONNECTION <br /> STATE SURCHARGE Yes�- No WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes �_ No SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> � — - <br /> Z01tL1iG CH�CK LIST zoning Dis�ricc: <br /> Fire Department: Post Offlce: School District: • <br /> Lot Area: Sq.ft. Acres Width Dep[h <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: <br /> Front(Lake): Ri�ht Side: � <br /> Reaz (Street): ft Side: <br /> Adjacent Structures: Wetland: . <br /> Building Height: Def. Het. i Peal:Hgt. <br /> Lot Covera�e: <br /> Grading: Staff Approval Date: I By: Council Approval Date: <br /> Sepuc: Staff Approval Date: � By: <br /> Zoning File: # Resolution: # Resolution Date: <br /> Shoreland District: I <br /> Avg. Setback: B uff Setback: L.otCoverage: <br /> E ' ting Proposed <br /> Hardcover: 0-75' �_ <br /> 75-250' <br /> 250.500' �_ <br /> 500-1000' <br /> �-- <br /> Hardcover Variance Required: Yes I No Date of Council Approval: <br /> gE1�1ARKS(in house): <br /> 7 <br />