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. • <br /> � CHECK OF'F LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: �33 3 �t-4-oC��—`^+-� �J2 <br /> PID: <br /> DESCRIPTION OF WORK: (Z,t�,v�c�XJ e C.. <br /> _ _---__--_-- -------- __ ---____---------- <br /> ---------------------------------------------------- <br /> ZOrTi 1G REVIEW BY: ���.�,.�i. DATE APPROVED: �0 �(/-v/ <br /> BUILD�tG REVIEW BY: DATE APPROVED: �o- �/-v/ <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PER�I�IIT Yes � No <br /> PLAi�1 REVIEW Yes _� No SEWER CONNECITON <br /> STATE SURCHARGE Yes ✓ No WATER CONNECTION <br /> INVESTIG_�TION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECT'ION <br /> Number of SAC Units OTHER (specify) <br /> Z0�1I�G CH�CK LIST Zoning District: /UD C/-fi9'rv6�.. <br /> Fire Department: Post Office: 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 Si e: <br /> Rear(Street): Left Sid : <br /> Adjacent Structures: Wetland: <br /> Building Height: Def. Hgt. Peak Hgt. <br /> Lot Coverage: � <br /> Grading: Staff Approval Date: I By: Council Approval Date: <br /> � <br /> Septic: Staff Approval Date: By: <br /> Zoning File: # Resolution: # Resolution Date: <br /> Shoreland District: <br /> Avg. Setback: Bluff Set;back: Lot Coverage: <br /> Existing ' Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> —� <br /> 250-500' <br /> 500-1000' <br /> --•— <br /> Hardcover Variance Required: Yes I�10 Date of Council Approval: <br /> REMARKS (in house): <br /> 7 <br />