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CHECK OFF i,IST FOR ISSUANCE OF PERiVIITS <br /> FOR OFFICE USE ONL�Y <br /> ADDRESS OR LEGAL: 4U �� ' ' <br /> PID: � <br /> DES�RIPTION OF WORK: ,�.'. l � �� �-- ���'" <br /> -------------------------------------- ----- --- <br /> ------ --- ----�- ,---- ------------- ' <br /> ZO�G REVIE�V BY: v _/� -. DATE APPJ20VED: '—`S / ? 06 <br /> BUILDING REVIEtiV BY: DAT`E APPROVED; <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes ✓� No <br /> PLAN REVIEtiV � Yes —,� No SEti�IER CO�INEC`T'ION <br /> STATE SURCHARGE Yes _ / No WATERCOiVNECTTON <br /> INVESTIGATION FEE Yes No —� PARK FEE <br /> SAC Yes No � SITEII�TSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ------------------------------------------------------------------ U <br /> ZONii�IG CHE.CK LIST Zoning Districr. 12— I /V' C �f��CJ� � <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 /> Froat (Lake}; Rioht Side: <br /> Rear(Street): Left Side: <br /> Adjacent Structures: Wetlan : <br /> Buildin� Height: Def. Hgt, Peal:Hgt. <br /> Lot Covera;e: <br /> Grading: Staff Approval Date: Council Approval Date: ' <br /> Septic: Staff Approval Date: �Y� <br /> Zonin� File: n Resolution: # Resolution Date: _ <br /> Shoreland District: <br /> Avg. Setback: Bluff Setba : L.ot Covera�e: <br /> E�isting Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 2�0-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Da�e of Council Approval: <br /> RE��L4RKS (in house): <br />