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� <br /> CHECK OFF LIST FOR ISSUANCE OF PEItNIITS <br /> ' � FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: _�y �j C�4� � �o�.�i ��-� <br /> PID: <br /> DESCRIPTION OF WORK: ��rC�S� l�c � <br /> ZO�iING REV�W BY: �I G� DATE�iPPROVED: <br /> BUII.DING REV�W BY: DATE APPROVED: �U —��-� <br /> FEES TO BE CHARGED: �1isc. Fees Calculated By: <br /> PERIVIIT Yes � No <br /> pLpN REVIEW Yes No (/ SEWER CONNECTION <br /> STATE SURCHARGE Yes ✓ No WAT'ERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No STTEI�i iSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZOti�VG CHECK LIST Zoning Disuict: �� _ (�F� <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes No Da[e of Survey: <br /> Proposed Setbacks: <br /> Front (Lake): Right Side: <br /> Rear (Street): Left Side: —j� <br /> Adjacent Structures: Wetla�d: <br /> Building Hei�ht: Def. Hgt. Peak gt• <br /> Lo[Covera�e: <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 /> Av�. Setback: Bluff Setback: L.ot Coverage: <br /> ExistinQ Proposed <br /> 0 <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): <br /> 7 <br />