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� <br /> CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: ��g�5 �3r1 Y s r�J� ��✓� <br /> PID: <br /> DESCRIPTION OF WORK: (_/vC.�,os.e c�iv2��t Lx •S r�.v(� �o2Cl-� - <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING REVIEW BY: DATE APPROVED: �-�Y�S g <br /> BUILDING REVIEW BY: DATE APPROVED: � -�� -S g <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes .� No <br /> PLAN REVIEW Yes � No SEWER CONNECTION <br /> STATE SUR:f-�ARGL Yes J No WATERCONNECTION <br /> INVESTIGA'I'ION FEE Yes No PARK FEE <br /> SAC Y.;s No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING CHECK LIST zoning District: N� Gl�h4'n+t�,Q. <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 /> FI'011i (Lake): Right ide: <br /> Rear (Street): Left S de: <br /> Adjacent Structures: Wetland: <br /> Building Height: Def. Hgt. 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 Dist.�i�t: <br /> Avg. Setback: Bluff S tback: L,ot Coverage: <br /> Existin 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 />