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- CHECK OFF LIST FOR ISSUANCE OF PERI�IITS <br /> � FOR OFFICE USE 0�1LY • . <br /> ADDRESS ORLEGAL: 2gSo �uv,�ei+.s-e-'r c� <br /> PID• �. <br /> DESCRIPTION OF WORK: ��� � • <br /> ZOVItiG REVIJ�`V BY: . _ DATE APPROVED: � •�-o� <br /> �. BL7LDL�iG RE`VIE�V BY: � � DATE APPROVED; 3-!g-o 0 <br /> FEES TO BE CHAItGED: Misc. Fees Calculated By: <br /> PERMIT Yes � No <br /> pLAI�T REVIEW Yes ✓ No SEWER CO�TFCITON _ <br /> STATE SURCHARGE Yes _� No WATERCONIVECITON <br /> IIWESTIGATION FEE Yes No P��E <br /> SAC Yes No ST�EINSPEC'ITON <br /> Number of SAC•Units OTHER(specify) <br /> ___________ - -- - --- --_ <br /> __________ <br /> ZO`Z`�'G CH�CK LIST Zoning Dis�icr. 24-lr3 <br /> Fire Department: (�cr�ti G4tu� Post Office: ((�^+�^+� School Dscrict: p2o�o� <br /> Lot Area: Sq.ft. Acres �.ctis � Width r�l''��� Depth <br /> Survey Submitted: Yes � No Date of Survey: �' `'� ' `�� <br /> Proposed Setbacks: <br /> i <br /> Front(Lake): 7c� Right Side: � �N��°' � . <br /> Rear(Street): 1�� Left Side: /SO <br /> � <br /> Adjacent Structures: 2s Wetland: /`���' <br /> Building Height: Def. Hgt. -� Peal:H;t. <br /> Lot Covera;e: (9���- ' <br /> Gradin;: Staff Approval Date: — By: Council Appro��l Date: <br /> Septic: Staff Agproval Date: — ' By: <br /> Zoning File: # '-' Resolution: # Resoludon Date: _ <br /> Shoreland District: N� <br /> Av�. Setback: Bluff Setback: Lot Co��rage: <br /> � Ezistmo Proposed <br /> Hazdcover: 0-75' ----- . <br /> . 75-250' ---- <br /> 2�0-500' ---- <br /> 500-1000' ---- <br /> Hardcover Variance Rcquired: Yes No Date of Council Approval: <br /> REI�I.ARKS ('in house): <br /> 7 <br />