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• ' CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE iJSE ONLY <br /> ADDRESS OR LEGAL: �`j P �% �' fl 5�=� r c�,��„ ; t'��:� <br /> PID: <br /> DESCRIPTION OF WORK: 5��;;`,,v�� �n�,,,,:�, �� �Z�,-�'.�t�('� <br /> ZOivING REV�W BY: � �'� DATE APPROVED: <br /> BUII..DING REVIEW BY: -_ � ��,,,,�.,,` DATE APPROVED: �-z� S�� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes �/ No <br /> PLAN REVIEW Yes No .�- SEVY�CONNECTION <br /> STATE SUR�F3ARGL Yes .� No WATERCONNECITON <br /> INVESTIGAZ'ION FEE Yes No � PARK FEE <br /> SAC Y::s No ' SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> �ZO�TING CHECK LIST zoning District: <br /> !V:: C:.�/���:�.:, <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: <br /> Front (Lake): _ Right Side: <br /> Rear (Street): Left Side: <br /> Adjacent Structures: Wetland: <br /> Buildin' Height: Def. Hgt. Peak Hgt. <br /> L.ot Coverage: <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File; # Resolution: # Resolution Date: <br /> Shoreland DisL-ict: <br /> Avg. Setback: Bluff Setback: Lot Covera�e: <br /> � Eziscing 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 /> • 26 <br />