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CHECK OFF LIST FOR ISSiJANCE OF PERMITS � <br /> FOR OFFICE USE ONLY � <br /> ADDRESS OR LEGAL: 3�{6 S S N�i.tZw� �� . <br /> PID• <br /> DFSCRIPTION OF WORK: Q�-�- (Lo on,.� — (L.r,w�-o r�e� <br /> ZO�tG REVIE�V BY: N (� DATE APPROVED: <br /> BUII.DI�i IG REVIEW BY: -.�_ DATE APPROVID; Z-c�-o�j <br /> FEES TO BE CHARGED: i�iisc. Fees Calculated By: <br /> PERNIIT Yes �No <br /> PLAl�T REVIEW Yes No ✓ SEWF�COrfNECTION <br /> STATE SURCHARGE Yes f No WATF1tCOrfNECTION <br /> INVESTIGATION FEE � Yes No ✓� PARK FEE <br /> SAC Yes NO � STTEINSPEC"TION <br /> Number of SAC�Units OTHER (specify) <br /> ZONING CH�CK LIST zoning District: N � G/-1�/V� <br /> Fire Department: Post Office: School Disuict: - <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: � <br /> Front(Lake): Right Si�: <br /> Reaz(Street): Left Side: <br /> Adjacent Structures: Netl . <br /> Building Height: Def. Hgt. Peak �. <br /> Lot Coverage: <br /> Gradino: Staff Approval Date: By Council Approval Date: <br /> Septic: Staff Approval Date: By:l <br /> Zoning File: # Resolution: # i Resoludon Date: <br /> � <br /> Shoreland District: <br /> Avg. Setback: Bluff Sewack: Lot Covera�e: <br /> Eus�iug Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' � <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: � <br /> RENIARKS(in house): <br /> 7 <br />