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< CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: '�2 O 5 �Q f�3� G�4-�l.� QR <br /> PID: <br /> DESCRIP'i'ION OF WORK: p�U� (�,�,hc(Z �/2 nxcdl S !?�P�eesr�,� <br /> -- — -------------------------------------�-----�--�--�-- <br /> ZO�G REV�W BY: � DATE APPROVED• G 9 � <br /> BUII,DING REV�W BY: DATE APPROVED: 6 -� -Q� <br /> F'EES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes r/ No <br /> PLAN REV�W Yes • No f SEWER CONNECTION <br /> STATE SUR��IARGL Yes � No WATERCONNECI'ION <br /> INVESTIGAZ'ION FEE Yes No PARK FEE <br /> SAC Y::s No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZOiVI�i 1G CHECK LIST Zoning District: �-> �(� C'�.f A/�J� �; <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres Width Depch <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: <br /> Front (Lake): _ Right Side: <br /> Rear(Street): Left Side: <br /> Adjacent Structures: �Vetland: <br /> Building Height: Def. Hgt. Peak Hgt. <br /> Lot Coverage: <br /> Gradin�: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoni.ng File; # Resolution: # Resolution Date: <br /> Shoreland DisL-ict: <br /> Avg. Setback: Bluff Setback: LotCovera�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 /> REMARKS (in house): <br /> • 26 <br />