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' CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> � FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 95l �P/l�N(,N�c.�- /1�•4� . <br /> PID• <br /> DESCRIPTION OF WORK: �qpp, �� 2�c.. <br /> Z0�1I�tG REVIEW BY: DATEAPPROVED: /�-/ -03 <br /> BUILDItii'G REVIEW BY: DATE APPROVED: �o-�=-a5 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes � No <br /> PLAN REVIEW Yes _� , No SEWER COTfNECTTON <br /> STATE SURCHARGE Yes _� No WATERCONNECTION <br /> INVESTIGATION FEE PARK FEE <br /> SA SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZONING CH�CK LIST Zoning District: ti o C�fia►s�c,p <br /> J <br /> Fire Department: Post Office: School District: � <br /> Lot Area: Sq.ft. Acres � Width Depth <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: � <br /> Froat(Lake): Right Side: <br /> Rear(Street): I.eft Side: <br /> Adjacent Structures: Wetl d: <br /> Building Hei�ht: Def. Hgt. Peal: gt. <br /> Lot Covera;e: <br /> Grading: Staff Approval Date: B Council Approval Date: <br /> Septic: Staff Approval Date: B : <br /> Zoning File: # Resolution: # Resolution Date: <br /> Shoreland District: <br /> Avg. Setback: Bluff Setbac : I,ot Coverage: <br /> Existing Proposed <br /> Hazdcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REI�ZARI�S (in house): <br /> 7 <br />