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� CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 1.�S �FLo w� (Lo� S_ � <br /> PID: - - - <br /> DESCRIPTION OF WORK: /-�pp��a� ' <br /> ZO.�tI�ti G REVIE`V BY: DATE APPROVED: 6• /7� a 3 <br /> BUII�DI'i�1G REV�`V B : DATE APPROVED: c � �7�� � <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERII�IIT Yes � No <br /> PLAi�1 REVIEW Yes � No SEWER CO�INEC'IION <br /> STATE SURCHARGE Yes �' No WATF.RCOiVNECTION <br /> INVESTIGATION FEE � Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC-Units OTHER (specify) <br /> ZONi��TG CHE.CK LIST Zonina District: . <br /> Fire Department: Post Office: School District: � . <br /> Lot Area: Sq.ft. Acres � Width Depch <br /> Survey Submitted: Yes_ c� No Date of Survey: 6 • /� �°3 <br /> Proposed Setbacks: � <br /> , , <br /> Fron[(Lake): ��• 5 --h Right Side: /0� ± <br /> Rear(Street): S 3-7 � � Left Side: `{$ ` ± <br /> Adjacent Structures: �¢-rrya c�G..��( �Vetland: �✓ � /� <br /> Building Hei�ht: Def. Hgt. � •K- Peal:Hot. <br /> Lot Covera?e: N I/� <br /> Gradin�: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: �' By: <br /> Zonino File: # — Resolution: # Resolution Date: <br /> Shoreland Dis[rict: /V� <br /> Avg. Setback: Bluff Setback: L,otCoverage: <br /> Ezistin� Proposed <br /> a <br /> Hardcover: 0-75' <br /> 75-250' <br /> 2�0-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council App:oval: <br /> RE�LA.RKS (in house)• <br /> 7 <br />