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. � <br /> CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: Z.gSS ,so,vi�R�r �.4s�-e <br /> PID: <br /> DESCRIPTION OF WORK: ,ll�J�.�p.t�.�l�,pO�na�-' <br /> ZO.�i 1G REVIEW BY: �- -- ----------------DAT'E APPROVED: g .y -o S-- <br /> BUII�DING REVIEW B : DATE APPROVED; g -Y-0 5" <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes _,� No <br /> PLAN REVIEW � Yes ,/' No SEWER CO�TNECTION <br /> STATE SURCHARGE Yes � No WATER CONNECTION <br /> INVESTIGATION FEE Yes No, �/" PARK FEE <br /> SAC Yes No �/ � SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZONI�IG C�CK LIST Zoning District: <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: pw �t t� <br /> Proposed Setbacks: <br /> Front(Lake): z.00' -+ Right Side: ��o' t <br /> Rear(Street): 1 y3� t Left Side: 93� �- <br /> Adjacent Structures: � /'V l� Wetland: — <br /> Building Height: Def. Hgt. p.(L Peak Hgt. <br /> Lot Covera�e: /✓/�4 <br /> GradinD: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # "—" Resolution: # Resolution Date: <br /> Shoreland District: Nc� <br /> Av;. Setback: Bluff Setback: Lot Coverage: <br /> Existin� Proposed <br /> a <br /> Hazdcover: 0-75' <br /> 75-250' <br /> 2�0-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Da[e of Council Approval: <br /> REviARKS (in house): <br />