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. � ` CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> � FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 3�y S SH U�ZX.C-1N C q 2 <br /> PID: <br /> DESCRIPTION OF WORK: �.�/�,,�, �,�P cr� F-r-- ,4�v� iZ�� p.�. <br /> ZO.YIYi G $.EVIEW BY: N�/� DAT'E APPROVED: <br /> BUII.,DING REV�`i� BY: DATE APPROVED; _�-�z-03 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes ✓ No <br /> PLAN REVIEW Yes No ✓ SEWER CONNECTION <br /> STATE SURCHARGE Yes ,/ No WATERCONNECITON <br /> INVESTIGATION FEE Yes No ✓ PARK FEE <br /> SAC Yes No �� SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZONING CHE.CK LIST Zoni.ng District: /U� GHAIvGc= <br /> Fire Department: Post O�ce: School District: <br /> I.ot Area: Sq.ft. Acres � Width Depth <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: � <br /> Front(Lake): Right Side: <br /> Rear(Street): Left Side: <br /> Adjacent Structures: Netl d: <br /> Building Height: Def. Hgt. Peal: 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 Di�trict: <br /> Avg. Setback: Bluff Setback: L,ot Coverage: <br /> Existing 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 /> RENLARKS (in house): <br /> A �/✓e� /1z� Cc�itf c.�►,�tHUC^ 5n4;z Q � Gad�P ��s�or! —�� c-�w S u-t< < N <br /> L:.�t S Tl�'�! ��/t c.-�O nr S•� <br /> 7 <br />