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; � CHECK OFF LIST FOR ISSUANCE OF PER��iITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: S`S Fc/Z�/O�}cx. 6«�� <br /> PID: <br /> DESCRIPTION OF`�ORK: ✓�cGess o2,,, ��O L <br /> ZOr�i'G REVIEti� BY: DATE APPROVED: G -�3"ov <br /> BUILDING REVIE`V BY: DATE APPROVED: 6- r 3 -�� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes t� No <br /> PLAN REVIEW Yes �/' No SEWER CONNECTION <br /> STATE SURCHARGE Yes �/ No WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No STTEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZOYL�G CH�CK LIST Zoning District: 2 -��`1 <br /> Fire Department: �nl�t�j-Gv�,-►� Post Office: �til,�,,,r--✓�-tYa School Disuict: � <br /> 'T <br /> Lot Area: Sq.ft. c Acres — Wid[h -- Depth �-- <br /> Survey Submitted: Yes � No Date of Survey: �.J /=�t�t� <br /> Proposed Setbacks: � <br /> Fron[(Lake): 3 y 5 � Rigb,t Side: ���� <br /> Rear (S[reet): `�y � '� Left Side: 1 53� <br /> Adjacent Structures: Z b� Wetland: Z 13 ' <br /> Building Height: Def. Hgt. �• k- Peal:Hgt. ' <br /> Lot Covera�e: — <br /> Grading: Staff Approval Date: �` By: Council Approval Date: <br /> Septic: Staff Approval Date: ` By: <br /> Zoning File: # ^ Resolution: # Resolution Date: <br /> Shoreland District: �v <br /> Avg. Setback: Bluff Setback: L.ot Covera�e: <br /> Ezisting Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REv1ARKS (in house): <br /> 7 <br />