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CHECK OFF LIST FOR ISSUANCE OF PERTNRTS <br /> FOR OFFICE USE ONLY- <br /> ADDRESS OR LEGAL: —Tor► <br /> DESCRIPTION OF WORK: � ��`� <br /> iii'!' IAB !b° �CPJ <br /> ---------- -—---------------DATE APPROVED:- � <br /> ZO' ]G REVIEW BY: <br /> F rt. �.. <br /> BUILDING REVIEW BY: DATE.A.PPROVED; j6 -1- 1)7 . <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes No <br /> PLAN REVIEW Yes No SEWER CONNECTION <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 /> ZO1 1 G CHECK LIST Zoning District: NO C I i AN(,e <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 /> Front(Lake): Right Side: <br /> Rear(Street): Left Side: <br /> Ad�acent Str coires: Wetl d: <br /> Building Height: Def, Hgt. Pe Hot. <br /> Lot Coverage: <br /> Gradin;: Staff Approval Date: B Council Approval Date: <br /> Septic:Staff Approval Date: JA By: (ox.� <br /> Zoaing File: Resolution: # Resolution Date: <br /> Shoreland District: <br /> Avor Setback: Bluff Setba Lot Covema <br /> &✓shun Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 25J-5GO' <br /> 5PIG-iCC) <br /> rerCv'- <br />