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CHECK OFF LIST FOR ISSUA��tCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> A.DDRESS OR LEGAL: �3Z5 �3{t owns �((,p�1 D So• <br /> PID: <br /> DESCRIl'T'ION OF WORK: ��-�� � <br /> -------_—___---_--_-------- --------- -- - ----------------------------------------- <br /> ZO.VIYi G REVlEW BY: � �Q,�,,t____- -------------DATE APPROVED: ��• ZK-o 5 <br /> BUII..D1I�G REV�W BY: DATE APPROVED: ��--z Y-o; <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Yes �/ No SEtiVER CONNECTION <br /> STATE SURCHARGE Yes � No WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ---------------------------------------------------------------------------------------------------------------------- <br /> Z0��1G CH�CK LIST Zoning Districc: <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sc.ft. Acres Width Dep[h <br /> Survey Submitted: Yes_� No Date of Survey: o� �2 <br /> Proposed Se[backs: <br /> Front (Lake): ,SOo' t Rijht Side: ^� ZOd � �' <br /> Rear (Street): S'6�� � Left Side: 5 S^na� + <br /> Adjacent Structures: ^3o f., (�w� s� Wedand: S�� �-- <br /> Buiidin� rieignt: Def. rigt. — reai:izot. — <br /> Lot Covera�e: � <br /> Grading: Staff Approval Da[e: — By: Council Approval Date: <br /> Septic: Staff Approval Date: -- By; <br /> Zoning File: # — Resolution: # Resolution Da�e: <br /> Shoreland District: /�C� <br /> Av�. Setback: Bluff Setback: L.ot Coverage: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 7�-250' <br /> 2�0-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> �NIARKS (in house): <br /> � <br />