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CHECK OFF LIST FOR ISSUANCE OF PERl�IITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 32—j � �s C.o G r(LC.C�I�� <br /> PID: <br /> DESCR�TION OF WORK: �Z_e�o �' o v� CC,�C_ <br /> ZO�G REVIE`Y BY: DATE APPROVED: �- Z�- v� <br /> BUILDPTG REVIE`V BY: DATE APPROVED: �- Z� -�� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Yes No �/ SE�VER CONNECI'ION <br /> STATE SURCHARGE Yes � No WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No STTEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZO�i� CH�CK LIST Zoning Disuict: /v� C l-Fs4r�� <br /> Fire Departmen[: Post Office: School Disuict: <br /> Lo[Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Se[backs: <br /> Front (Lake): Right Side: <br /> Rear (Street): Left Side: <br /> Adjacent Structures: Wetland: . <br /> Building Height: Def. H;t. Peal:Hgt. <br /> Lot 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 /> Avg. Setback: Bluff Setback: Lot Coverage: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REi�1A.RKS (in house): � cG� �1--�c � � r ss-e.� `�- 0� <br /> 7 <br />