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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: Z�y �; C����-c; �c;�,.�"+ �2..c,� <br /> PID: <br /> DESCRIPTION OF WORK: (a-�n n�,,��,-., <br /> ZO�G REV�W BY: DATE APPROVED: )�- 25- �� <br /> BUII.DING REVIE`� BY: � ,_ � ti�,L,_ DATE APPROVED; t►- zs -� � <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes _� No <br /> PLA1�1 REVIEW Yes _/ No SEWER CONNECTION <br /> STATE SURCHARGE Yes _�� No WATER CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZO�TING CH�CK LIST Zoning District: <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes� No Date of Survey: ►-i J -�7- <br /> Proposed Setbacks: <br /> �eat (Lake): ��S'� �' Right Side: �-t'i <br /> Rear (Street): I 23� �= Left Side: "?�; ' <br /> Adjacent Structures: �4��+e�y Wetland: /v 1,�a <br /> BuildingHeigh[: Def. Hgt. �.(� Peal:Hgt. <br /> Lot Coverage: � <br /> Grading: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning FIle: # — Resolution: # Resolution Date: <br /> Shoreland District: ..�-�� <br /> Avg. Setback: �, � Bluff Setback: ��f� _ L.otCoverage: — <br /> Ezisting Proposed <br /> Hazdcover: 0-75' <br /> 75-250' Z 7`�� � <br /> 250-500' � <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS (in house). �k �?.�-�,;�i,�y �)���-w�� � ���-�l'��_�.�r� <br /> 7 <br />