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' CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> � ADDRESS OR LEGAL: �-i 4 0 (��,o w N (Lo,A�.(J <br /> PID: <br /> DESCRIPTION OF WORK: �3p�s�cM�r-- (L�.��,r�,e� <br /> ZOrTi 1G REVIEW BY: �/A DATE APPROVED: <br /> BUII.DING REV�W BY: DATE APPROVED; Z 7•�Z <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PER�v1IT Yes ,� No <br /> PLA��t REVIEW Yes f No SEWER CONNE�TION <br /> STATE SURCHARGE Yes �/ No WATER CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZO�TING CH�CK LIST Zoning District: Nc� C��►�9/vG�,� <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres idth Depth <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: <br /> Front (Lake): Right Side: <br /> Rear (Street): Left Side: <br /> Adjacent Structures: Wetland <br /> Building Height: Def. Hgt. Pea�:Hg . <br /> Lo[Covera?e: <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File: # Resolution: # Re olution Date: <br /> Shoreland District: <br /> Avg. Setback: Bluff Setback: L.o[Coverage: <br /> Existing 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): p F G�R� r a•-! �'yC� l�z� �-�-< <br /> -• r--�c T��� <br /> 7 <br />