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.� CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> " FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: �� 3 c� s�Rx,c,.,.+� �Q�.�-e <br /> PID• <br /> DESCRIPTION OF WORK: r—_-,�r�-r�cv ,�y�•orv�,�a� — L�S� 7��s� <br /> ZO�TG REVIEW BY: DATE APPROVED: s-�o •� <br /> BUII.DING REVIEW BY: DATE APPROVED: S-�o -o� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes r/ No <br /> PLAN REVIEW Yes � No SEOV'F.R CONNECTION <br /> STATE SURCHARGE Yes ►�' No WATERCONNEG"TION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No STTEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZOti�G CH�CB LIST Zoning Districr. � C N-�tr-�P <br /> Fire Department: Post Office: School District: � <br /> Lot Area: Sq.ft. Acres idth Depth <br /> Survey Submitted: Yes �� No Date of Survey: D�/ r'i � <br /> Proposed Setbacks: � . � <br /> Front(Lake): � -� Right Side: Ca./C <br /> Reaz(Street): C9-ic Left Side: b� <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 Da[e: By: <br /> Zoning File: # Resolution: # Resolution Date: <br /> Shoreland District: <br /> Avg. Setback: Bluff Setback: Lot Coverage: <br /> Existing Proposed <br /> Hazdcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hudcover Variance Required: Yes No Date of Council Approval: <br /> REv1ARKS(in�house): _ <br /> 7 <br />