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� <br /> � CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> , FOR OFFICE USE ONLY , <br /> ADDRESS OR LEGAL: �/�!0 �STL� <br /> PID: <br /> DESCRIPTION OF WORK: od <br /> - ----- --- -- ----------------- Z <br /> ZOYPi tG REVIE`V BY: DATE APPROVED: Q- Y-�y <br /> BUII..DI�IG REV�`Y B • DATE APPROVED; �}- Z�l-d`� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERII�IIT Yes � No <br /> PLAN REVIEW Yes � No SEWER CONIVECI'ION <br /> STATE SURCHARGE Yes � No WATERCONNECTION <br /> INVESTIGATION FEE � Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC-Units OTHER (specify) <br /> ZOi�TIl�iG 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: ON'r'�u= <br /> Proposed Setbacks: � <br /> Front(Lake): 2 oti� } Right Side: Z 3�� �= <br /> Rear(Street): 2� � } Left Side: Y6� <br /> Adjacent Structures: w � Netiand: Sa' <br /> Building Hei�ht: Def. Hgt. Peak Hgt. — <br /> Lot Coverage: /J�A <br /> Gradino: Staff Approval Date: � By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # — Resolution: # Resolution Date: � <br /> Shoreland District: /J(J <br /> Avg. Setback: Bluff Setback: L,ocCoverage: <br /> ExistinQ Proposed <br /> e <br /> Hardcover: 0-75' . <br /> 75-ZSO' <br /> 250-500' <br /> 500-1000' <br /> Hazdcover Variance Required: Yes No Date of Council Approval: <br /> REP�ARKS (in house): <br /> 7 <br />