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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: ��L`�� .�t�v���,;c:;;e'j <br /> PID: <br /> DESCRIPTION OF WORK: ��k�z����:;�: �� >i+���� w`�'`� <br /> ----- --- ____-- ---------------------------------------------------------------------- <br /> ZO�'G REV�`V BY: i._i��- `1 i/k�ti%'�---���`"'�c`•�.DATE APPROVED: �� '3� -`1(� <br /> BUILDI�i 1G REV�W BY: fv" �'�i�- DATE APPROVED; <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Yes No �-- SEWER CONNECTION <br /> STATE SURCHARGE Yes �,�/'' No WA'I'ERCONNECTTON � <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONLVG CH�CK LIST Zoning District: %U'f+-% G l��ti(�f�' <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres Width Depch <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: <br /> Front(Lake): Right Si e: <br /> Rear (Street): Left Sid : <br /> Adjacent Structures: �Wetland: <br /> Building Height: Def. Hgt. iPeal:Hgt. <br /> I <br /> Lot Coverage: � <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: I By: <br /> Zoning File: # Resolution: #� Resolution Date: <br /> Shoreland District: � <br /> Avg. Setback: Bluff Setb ck: L.ot Coverage: <br /> Ezisting Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' '' <br /> 500-1000' 1�, <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS (in house): <br /> 7 <br />