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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: z�S'� s t+an.��-w� /J2 � . <br /> PID: - --- -- - <br /> DESCRIP'ITON OF WORK: �L�,-�.�,,, �J?x-�►��z <br /> ZO.�tI�ti G REVIEW BY: N �✓� DATE APPROVED: <br /> BUII.DING REV�W BY: ��,,,e DATE APPROVED; -�• ��. �>� � <br /> FEES TO BE CHARGED: . Misc. Fees Calculated By: <br /> PER�I�IIT Yes ,/' No <br /> PLAN REVIEW Yes � No SEWER CONNECITON <br /> STATE SURCHARGE Yes c/ No WATERCONNECTION <br /> INVESTIGATION FEE � Yes No PARK FEE <br /> SAC Yes No SITEINSPECTTON <br /> Number of SAC�Units OTHER (specify) <br /> ZOl�'Il�TG CI�CK LIST Zoning District: � C Naow�,/ <br /> Fire Department: � Post O�ce: School District: • � � <br /> Lot Area: Sq�.ft. Acres � Width Depth <br /> Survey Submitted: Yes � No Date of Survey: <br /> Proposed Setbacks: � � <br /> Front(Lake): Right Side: � <br /> Reaz(Street): Left Side: <br /> Adjacent Structures: W tland: . <br /> Building Height: Def. Hgt. Pe •Hgt. <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 Setb ck: Lot Coverage: <br /> g���g Proposed <br /> Hazdcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes o Date of Council Approval: <br /> RENIARKS(in house): <br /> 7 <br />