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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: //5 5/h � TN /�u�= <br /> PID: <br /> DESCRIP'IZON OF WORK: cvGll.o.,+V o 0 <br /> ZO�iG REVIEW BY: DATE APPROVED: �i-r� • �-( <br /> BUII.DI�i IG REY�`V BY: DATE APPROVED; 9 -(o. �'� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERIVIIT Yes � No <br /> PLA��T REVIEW Yes No SEWE.R CO�TNECTION <br /> STATE SURCHARGE Yes � No WATERCONNECTION <br /> INVESTIGATION FEE � Yes No PARK FEE <br /> SAC Yes No STTEINSPECTION <br /> Number of SAC-Units OTHER (specify) <br /> ZO�TING CHE.CK LIST Zoning District: �, <br /> Fire Department: Post Office: School District: � <br /> Lot Area: Sq.ft. Acres � Width Depth <br /> Survey Submitted: Yes_� No Date of Survey: 1 �� ' 0�3 <br /> Proposed Setbacks: � <br /> Front(Lake): �y�� = Right Side: `'��� � � <br /> ` �' � � <br /> Reaz(Street): I l� Left Side: � $ <br /> Adjacent Structures: �0' * Netland: -- <br /> Building Hei�ht: Def. Hgt. -- Peal:Hgt. <br /> Lot Coveraoe: <br /> Gradina: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: � BY: <br /> Zoning File: # — Resolution: # Resolution Date: � <br /> Shoreland District: /\t d <br /> Avg. Setback: Bluff Setback: _ I.ot Coverage: <br /> EzistinQ Proposed <br /> 0 <br /> Hazdcover: 0-75' . <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hazdcover Variance Required: Yes No Date of Council A�roval: <br /> REI�ZARKS (in house): <br /> 7 <br />