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CHEC�K OFF LIST FOR ISSUANCE OF PERIVIITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: ��o� 3ro �s � �� ' S � - <br /> PID: <br /> DESCRI�TION OF WORK: <br /> ---------------------------------------��------ <br /> ------ --- -------- —__ ----�-�=-7r------- r / � <br /> ZONING REVIE�V BY: ` DATE APPROVED: CG�� "'J�G <br /> BU]ZDING REVIEtiV BY: <br /> ' DAT'E APPROVED: 6 - 1� -0� <br /> F'EES TO BE CHARGED: / Misc. Fees Calculated By: <br /> PERMIT Yes �/ No <br /> PLAN REVIEtiV � Yes �� No SEtiVER CONNECTION <br /> STATE SURCHARGE Yes V'. No tiVATERCONNECTION <br /> INVESTIGATION FEE Yes No _�' /PARK FEE <br /> SAC Yes No �/ SITEINSPECTION <br /> Number of SAC Units OTHER (speci£y) <br /> ------------- --- <br /> ---------------------------------�*---------(--'-- - <br /> ZONii�tG CH�CK LIST Zoning Districr. � `--�`---' � f-f <br /> Fire Department: Post Office: School District: <br /> , �;.� r�?; j � � �: -�: <br /> � .... <br /> Lot Area: Sq.ft. ������-J Acres Width ' �' Depch <br /> Survey Submitted: Yes I�fo Date of Survey: <br /> Proposed Setbac / �ti'���Z�? � � � . <br /> Froa (Lake • 2� Rioht Side: � �� � <br /> G / <br /> Rear(Street): � 1 Left Side: <br /> Adjacent Stnscniret: i4-�ci�-�U� Wetland: C� J� <br /> Builclin� Height: Def. Hgc. O- � Feak Hgt. -- <br /> { : <br /> Lot Covera�e: . � � � "'')`��t�s� �-_� <br /> Grading: Staff Approval Date: �� C�2�u� By: Council Approval Date: <br /> Szptic: Staff Approval Date: � (� By: � �r- <br /> Zoaing File: {t oS-3��� Resolution: # Resolution Date: <br /> � ��� t I ,� �/ �r r r � F �� Q �_.., <br /> Shoreland Distric[: �..- t� �� <br /> Avg. Secback: Bluff Setback: I.ot Covera�e: <br /> E�istin� Proposed <br /> � Hardcover: d-75' 2"i�H �'' '�'�� <br /> ��/ 6�'�"jd �� 7�-250' Sr 7_`', C,, Zt'' � <br /> U��" ' 2�0-500' <br /> 500-1000' <br /> H��dco��er Variznce Requi;ed: Yes �' No Da�e of CotLncil Approval: C� Z7�l,'���� <br /> FE�L4RKS (in house): <br />