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� <br /> , <br /> CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE NLY <br /> ADDRESS OR LEGAL: Zr87 � (�SGc� o�rv i l2o AY <br /> PID: <br /> DESCRIPTION OF WORK: �cc� �Pc/aC:.P � c�1�4-�� <br /> Z0��1G REVIEW BY: DATE APPROVED: q- � -o� <br /> BUII..D�tG REVIEW BY: DATE APPROVED; � -5'-�( <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNiIT Yes �/' No <br /> PLA1�1 REVIEW Yes � No SEWER CONNEC"ITON <br /> STATE SURCHARGE Yes �/ No WATERCONNECITON <br /> INVESTIGATION FEE Yes � No ���`'� PARK FEE <br /> SAC Yes No SITEINSPECTTON <br /> Number of SAC Uruts OTHER (specify) <br /> -- --------- ----------- --�='-�2�4__!Jo�s_P �--�/o �-r <br /> � ZO�TING CH�CK LIST Zoning District: <br /> Fire Department: Post Office: School District: <br /> � <br /> [Area: Sq.ft. Acres Width Dep[h <br /> Survey Submitted: Yes� No Date of Survey: Q'2�` � � <br /> Proposed Setbacks: <br /> Fron[(Lake): (00� Right Side: �'j�( � �' <br /> Rear (Street): � ?.c) Left Side: <br /> �7 ' .4 <br /> Adjacent Structures: /}'T��� `Vetland: r!I�A <br /> Building Height: Def. Hgt. �V � I'� Peal:Hgt. <br /> Lot Covera�e: 0 � � <br /> Grading: Staff Approval Date: '— By: Council Approval Date: <br /> Sep[ic: Staff Approval Date: --- By: <br /> Zoning File: # � Resolution: !# Resolution Date: <br /> Shoreland District: �./-Ps <br /> Avg. Setback: � ��� Bluff Setback: I.ot Coverage: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' Z�-/ •2 <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No_� Date of Council Approval: <br /> REMARKS (in house): ��e �rw p�4r�'� ��L� - v � �� s�� /�G�-,J <br /> 7 <br />