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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> ,. FOR OFFICE USE ONLY <br /> . ADDRESS OR LEGAL: 3s a s o�-r-t-� �32A w�v i�2..o r�✓-� <br /> PID: <br /> DESCRIPTION OF WORK: n�1 <br /> ZO.�tI�Ti G REV�W BY: DATE APPROVED: (� •Z'�/-� L <br /> BUII�DI�i TG REV�W BY: DATE APPROVED: G •ZY-o Z <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes _1� No <br /> PLAl�1 REVIEW Yes _� No SEWER CONNECTION <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 /> ZONING CH�CK LIST Zoning District: <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 /> rj <br /> Front (Lake): .SZd ± Righ[Side: 8J <br /> Rear (Street): �/`/c� Left Side: 2o a� � <br /> Adjacent Structures: �c� `Vetland: �-/l <br /> Building Height: Def. Hgt. �— Peal:Hgt. ^ <br /> Lo[Coverage: '— <br /> Gradina: 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 Setback: L.ot 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): �- �wv�� �-=��c- �5'c, <br /> ��� , <br /> 7 � �� �t <br /> �� / <br />