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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: /S�v �S�K r'r� �9 u� N <br /> PID: <br /> DESCRIPTION OF WORK: (��Gts S <br /> Z0.�1Iv.i G REV�W BY: DATE APPROVED: �z- i 3 _c,s <br /> BUII.DII�G REVIEW BY: DATE APPROVED: �Z-�3 -�s- <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes �/ No <br /> PLAN REVIEW � Yes ✓ No SEWF�t CONNECTION <br /> STATE SURCHARGE Yes J No WATER CONNECrION <br /> INVESTIGATION FEE Yes No �/ PARK FEE <br /> SAC Yes No � SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> Z0�1I�TG CH�CK LIST Zoning District: No Gi.tia,n,�,e_ <br /> Fire Depaztment: Post Office: School District: <br /> Lot Area: Sc.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: W i n.�,„/ `(,e�S.f <br /> Adjacent Struccures: Wetland: �c-f �$i9�9 /��`�`� <br /> Building Height: Def. Hgt. Peal:Hgt. W �T�'� N� �� <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 /> Av�. Setback: �v/� Bluff Setback: .✓��- Lot Coverage: — <br /> Ezistmg Proposed <br /> Hardcover: 0-75' <br /> 7�-250' +`�-� <br /> 2�0-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No_� Date of Council Approval: <br /> gZEI�iA�2KS (in house): <br /> 7 <br />