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' � CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: /5l�2 aA��E�c QMcI� /lo� <br /> PID: <br /> DESCRIPTION OF WORK: Q�Ut 6L��G4cc�svr.c.-�vT <br /> ZO�tPi IG REVIEW BY: DAT'E APPROVED: s- �-�y <br /> BUII.,DI�i 1G REV�W BY: DATE APPROVED; s. 7-o y <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes _�/ No <br /> PLAi� REVIEW Yes �/ No SEWER CONNECTION <br /> STATE SURCHARGE Yes (/ No WATERCONNECTTON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CH�CK LIST Zoning District: N v C�-ir4�v <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes No I Date of Survey: <br /> Proposed Se[backs: <br /> Front (Lake): Right y�ide: <br /> Rear (Street): Left Si�ie: <br /> � <br /> Adjacent Structures: i �Vetland: <br /> � <br /> Building Height: Def. Hgt. J Peak Hgt. <br /> Lot Coverage: <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File: # Resolution: # Resolution Date: <br /> Shoreland District: <br /> Avg. Setback: Bluff S tback: L,ot Coverage: <br /> Eust' b 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): /l,c;Pvq c..en�� o�= � Dcz/� r+��t.o�� Bti <br /> n�=�wno ,� � z�z� , <br /> � <br />