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CHECK OFF LIST FOR ISSUANCE OF PERI�IITS <br /> FOR OFFICE USE ONLY • <br /> ADDRESS OR LEGAL: l 9 S S SN nCz�U�� 02 <br /> PID: <br /> DESCRIPTION OF WORK: (L�'�t,`c� S f t�..� — 5 r�4,� S�� <br /> ZO�G REVIE�v BY: DATE APPROZ�D: 3 -1 C7-o v <br /> �. BL'II..DLti G REY�`�BY: -- � � DATE APPROYED; . . � <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes � No <br /> pI,�,N REVIEW Yes No_�� SEGVF�t CO�'ECTION _ <br /> STATE SURCHARGE Yes �No WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No STTEPi t�PECITON <br /> Number of SAC•Units OTHER(specify) <br /> _------�---------- <br /> ZO�Z`�G CH�CS LIST Zoning Districr. 6 ' Z- 0U� C'�ti�� <br /> Fire Department: L L Post Office: vt�t� School Dstrict: O R,o�v <br /> Lot Area: Sq.ft. Acres ' Width Depth <br /> Survey Submitted: Yes No Date Survey: <br /> Propased Setbacks: <br /> Front(Lake): Right Side: � � . <br /> R�ar(Street): Left Side: <br /> Adjacent Structures: Wetland: <br /> Buildin;Heiaht: Def. Hgt. Peal:Hgt. <br /> Lot Covera;e: ' <br /> Gradin;: Staff Approval Date: By: Council Appro��1 Date: <br /> Septic: Staff Agproval Date: By: <br /> Zonin�File: # Resolutioa: # Reso udon Date: <br /> Shoreland District: <br /> Avg. Setback: Bluff Setback: LotCo�zra�e: <br /> � Ezistmg ,! Progos�d <br /> Hardcover: 0-75' � . <br /> . 75-250' --- <br /> 250-500' u -- <br /> 500-1000' �I� <br /> �', <br /> Hardcover Variance Required: Yes No � Date of CouncL Approval: <br /> REVIARKS ('in house): � 'I <br /> , <br /> 7 <br />