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� � CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: I g� u 51-4c��.�►rv c �JJ 2 � <br /> PID: <br /> DESCRIPTION OF WORK: �,vti o�o e�/�(,�.�p�.i�2 <br /> � <br /> ZO.�tI�Ti G $EVIEW BY: DATE APPROVED: z•3-03 <br /> BUII.DI1i 1G REVIEW BY: DATE APPROVED; z� 3-�3 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes ✓ No <br /> PLAN REVIEW Yes � No SEWER CONNECITON <br /> STATE SURCHARGE Yes ✓ No WATERCONNECTTON <br /> INVESTIGATION FEE � Yes No PARK FEE <br /> SAC Yes No STTEINSPECTION <br /> Number of SAC-Units OTHER (specify) <br /> ZONING CHECK LIST Zoning District: i1/'p CH�W'�Q. <br /> Fire Department: Post Office: School District: • <br /> Lot Area: Sq�.ft. Acres � idth Depth <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: � <br /> Front(Lake): Right Side: <br /> Rear(Street): I.eft Side: <br /> Adjacent Structures: Wetl d: <br /> Building Height: Def. Hgt. Peak gt. <br /> Lot Coverage: <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File: # Resolution: !/ Resolution Date: <br /> Shoreland District: <br /> Avg. Setback: Bluff Setback: Lot Coverage: - <br /> Existin; Proposed <br /> Hazdcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hazdcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS(in house): <br /> 7 <br />