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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> �► FOR OFFICE USE ONLY <br /> � � ADDRFSS OR LEGAL: Z3'7� s N�+v��w o a0 � <br /> PID: <br /> DESCRIPTION OF WORK: F, �s�+ SN�-�.�. ��rn � <br /> ZO.vI�ii G REVIEW BY: ►r4 DATE APPROVED: <br /> BUII�DING REVIEW BY: ,�.` DATE APPROVED: �-t• a� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW � Yes _� No SE`VER CONNECTTON <br /> STATE SURCHARGE Yes �/ No WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes � No SITEINSPECTION <br /> Number of SAC�Units 1 s�,� n,�,e�r�.,,Nut��OTHER (specify) <br /> ----------------------------------- -----_-----------�_8�°5-------------------------------------------------- <br /> ZO�TING CH�CK LIST Zoning Districc: ivo G Ft�asv�� <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft.• Acres Width Depth <br /> Survey Submitted: Yes N Date of Survey: <br /> Proposed Setbacks: <br /> Front(Lake): Right Sid : <br /> Rear(Street): Left Side: <br /> Adjacent Structures: etland: <br /> Building Height: Def. Hgt. Peak Hgt. <br /> Lot Covera�e: <br /> Gradina; Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File: # Resolution: # Resolution Date: <br /> Shoreland District: <br /> Av;. Setback: Bluff Setba k: LotCoverage: <br /> Ezisling PlOposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> RENiARKS (in house): <br /> / <br />