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rt �, <br /> CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: �7 S (3��w�,�/ (�d�-� <br /> • PID•� <br /> DESCRIPTION OF WORK: /}ppi,.f�, ��G�1•,-�s �,S7�g-,/ts f-a c�� � g,—„�5 �j�2i;¢(,Q <br /> ------------------------------------------ --- -------------------------------------------------------------------- <br /> / <br /> ZONING REVIEW BY: DATE APPROVED: <br /> BUILDING REVIEW BY. DATE APPROVED: <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes �/ No <br /> PLAN 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 /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING CHECK LIST Zoning District: /f� C'/��(� <br /> � <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 /> Front (Lake): Rig Side: <br /> Rear (Street): Left ide: <br /> Adjacent Structures: Wetland: <br /> Building Height: Def. Hgt. Peal: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 District: <br /> Avg. Setback: Bluff Setba k: Lot Coverage: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' �i <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> i <br /> REMARKS (in house): p <br /> 7 <br />