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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 2`i$c� C�s� P o��v� 12.t�/�,� <br /> PID: <br /> DESCRIPTION OF WORK: rq.p(� �-n�N/�v►� o e� <br /> - ------------ - ------ -----------------------------------------�-----------�--- <br /> ZO:VI�i IG RE'VIE`V BY: DATE APPROVED• �7-3U Y <br /> BUII..DJ�1G REV�`V BY: DATE APPROVED; 6-3�-v�c <br /> FEES TO SE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes ✓ No <br /> PLAN REVIEW Yes ✓ No SEWER COI�INEC'ITON <br /> STATE SURCHARGE Yes � No WATERCONNECITON <br /> INVESTIGATION FEE Yes No �' PARK FEE <br /> SAC Yes No _� STTEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHE.CK LIST Zoaing District: <br /> Fire Department: Post Office: School Districr. <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes � No Date of Survey: Z-�`�-`�S� <br /> Proposed Setbacks: <br /> Front(Lake): I bo` Right Side: Z2' <br /> Reaz (Street): 00` Left Side: t�3 � <br /> Adjaceat Structures: i4-'rtY�c t-r�� `Vetland: ��� <br /> Building Height: Def. Hgt. O.�-- Peak Hot. — <br /> Lot Coverage: f9�1� <br /> Grading: Staff Approval Date: –' By: Council Approval Date: <br /> Septic: Staff Approval Date: -- By: <br /> Zoning File: # — Resolution: # Resolution Da[e: <br /> Shoreland District: <br /> Avg. Setbac : p d.(L Bluff Setback: r/��t I.otCoverage: D-(< <br /> EzistinQ Proposed <br /> 0 <br /> Hardcover: 0-75' <br /> 75-250' i�•t�6 L.�L�— <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No�L _ Date of Council Approval: <br /> REMARKS (in house): <br /> 7 <br />