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� <br /> � CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: �c�3o ('u�s c.� �Pa��v T �/+�✓� <br /> PID: <br /> DESCR�TION OF WORK: p,p � ;�o,✓ ru.��� <br /> ------------_____----_------ ---------------------------------------- . <br /> -------------------------- ---- <br /> ZO.vP1i G REV�W BY: ��� DATE APPROVED• g �-o� <br /> BUII.DI�G REVIEW BY: O .,,G �.._-- DATE APPROVED: �- � -�S <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Yes ,/ No SEWF.R 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�1IVG CH�CK LIST Zoning District: �2- � �- <br /> Fire Department: Post Office: School Distric[: <br /> �i7@ sN-oµ=Z+n�P � <br /> Lot Area: Sc.ft. 30�qL"? Acres .�� Width �s3CJ �S � Depch <br /> Survey Submitted: Yes�_ No Date of Survey: <br /> Proposed Setbacks: � <br /> Front (Lake): I'Z� f Right Side: 0 t n o <br /> Rear (�eet�: ZD� /5 ' Left Side: /`���1 <br /> �lop�r�v.� o�e.� �RR�' t t�v�/�r� <br /> Adjacent Structures: _,q..�77�ru-�-P� Wetland: /�W} <br /> Building Height: Def. H;t. a-(� Peak Hgt. — <br /> Lot Covera;e: cn-. t� <br /> Grading: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: ^ By: <br /> Zoning File: # ps-3►y0 Resolution: # Resolution Date: �- � '�S <br /> Shoreland District: �,,, ,O�_ _ <br /> Av�. Setback: � o�u+_ Bluff Setback: � L.ot Co�'erage: <br /> Ecisting Proposed <br /> Hardcover: 0-7�' �'�� <br /> 7�-250' w v <br /> 2�0-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No� Date of Council Approval: <br /> RE1�IARKS (in house): <br /> � <br />