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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 3�S 5 u.vc:2 �c►��aw �R- <br /> PID: <br /> DESCRIPTION OF WORK: (J—�-�cKc�O C��4rr��2 <br /> ZOYPi iG REV�`V BY: - - --' DAT'E APPROVED: �o • t - n Y <br /> BUII,D�[G REY�`Y BY: DATE APPROVED; � o - � �d ti <br /> FEES TO BE CHA.RGED: Misc. Fees Calculated By: <br /> PER11i1IT Yes �/ No <br /> PLAI�i REVIEW Yes ✓ No SE�VER CO�INECITON <br /> STATE SURCHARGE Yes �/ No WATF�tCONNECTION <br /> INVESTIGATION FEE � Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC-Units OTHER (specify) <br /> ZO�iI�1G CHE.CK LIST Zoning Discricc: �. <br /> Fire Department: Post O�ce: School District: � <br /> Loc Area: Sq.ft. Acres � Width Depth <br /> Survey Submitted: Yes�_ No Date of Survey: �rr i-��� <br /> Proposed Setbacks: � <br /> ± ' <br /> Fron[(Lake): 1 b�3� Right Side: � g 8 = <br /> � - � <br /> Rear (Street): �Z 9•S 3 Left Side: �`�'y — <br /> Adj acen[Structures: 3�•5� Wetland: /V/�' <br /> Building Hei�b.t: Def. Hgt. o.1� Peak Hgt. <br /> L,ot Coveraoe: � �� <br /> Gradino: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: � BY: <br /> Zoning File: # � Resolution: # Resolutioa Date: � <br /> Shoreland District: N� <br /> Avg. Setback: Bluff Setback: LotCoverage: <br /> Existing Proposed <br /> Hazdcover: 0-75' . <br /> 75-250' � <br /> 250-500' <br /> 500-1000' <br /> Hazdcover Variance Required: Yes No Date of Council Approval: <br /> RE1�ZAltKS (in house): <br /> 7 <br />