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. . <br /> CHECK OFF LIST FOR ISSUA:\CE OF PERMITS <br /> FOR OFFICE USE O�tLY <br /> ADDRESS OR LEGAI,: 2$�� C R�� t!�rn�a` <br /> PID• <br /> DESCRIPTION OF�ORK: L/-�l� /+�cx—�S s'���/�S <br /> Z0.�1I�1i G REVIE�ti' BY: DATE APPROVED: I/- �1S -�3 <br /> BUII�DING REVIE�V BY: DATE APPROVID; r � -�o-0 3 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PER�ViIT Yes � No <br /> PLAi�1 REVIEW Yes � No SEWER CONNECITON <br /> STATE SURCHARGE Yes No WATERCONNECITON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No STTEINSPECTION <br /> Number of SAC-Un.its OTHER (specify) <br /> ZONING CH�CK LIST Zoning District: d• I C <br /> Fire Department: Post O�ce: School District: <br /> Lot Area: Sq.ft. Acres idt1 Depth <br /> I <br /> Survey Submitted: Yes No � Da:e of Survey: <br /> Proposed Setbacks: � <br /> Front (Lake): Right Side: <br /> Reaz (Street): Left Side: <br /> Adjacent Structures: Wetland: <br /> Building Hei�ht: Def. Hgt. Peal:Hgt. <br /> L.ot Coverage: <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File: �# Resoluuon: # Res�lution Date: <br /> Shoreland District: <br /> Avg. Setback: Bluff Se[back: L.ot 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 /> REMARKS (in house): <br /> 7 <br />