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� CHECK OFF LIST FOR ISSUAl�tCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: /�/Z y (�/�c-or�2 �iM.�� �� <br /> PID: <br /> DESCRIPTION OF WORK: �,r,� �,,,�uc t wi,�ve� .r,�ss�.�f -� Ne•,� �asr <br /> Z0�1P1G REVIEW BY: DATE APPROVED: �r-3o-o �' <br /> BUII�DIti G REVIE`V BY: DATE APPROVED: 4 • 3� -a3 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes �/ No <br /> PLAN REVIEW Yes v No SEWER COi�iVECTTON <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 /> ------------------------------------------------------------------------------------------------------------------------ <br /> Z0�1I�1G CH�CK LIST Zoning District: <br /> Fire Department: Post Office: School Dis[rict: <br /> Lot Area: Sc.ft. Acres Width Depch <br /> Survey Submitted: Yes _�_ No Date of Survey: �� �i� <br /> Proposed Setbacks: <br /> Front (Lake): Right Side: <br /> Rear (Street): Left Side: <br /> Adjacent Structures: W dand: <br /> Building Height: Def. Hgt. Peal:Hbt. <br /> Lo[ 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: <br /> Av�. Setback: Bluff Setback L.otCoverase: <br /> Ezisting Proposed V <br /> Hardcover: 0-75' <br /> 7�-250' <br /> 2�Q-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REiL1ARKS (in house): <br /> � <br />