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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: ZS� c� C,/-�5� �o w i V�o r4-/J <br /> PID: <br /> DESCRIPTTION OF WORK: �]�C,1� � n��tv sCJ�QN �Pol�.� H <br /> ZO.vI�Ii G REVIE�V BY: DATE APPROVED: �-�-G S <br /> BUII�DI�i �'G REVIEW BY: DATE APPROVED: � $-o S <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes _� No <br /> PLAN REVIEW � Yes r/ No SEWF.R CONiVECTTON <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 /> ZO��tIVG CH�CK LIST Zoning District: <br /> Fire Department: Post Office: School Districr. <br /> Lot Area: Sc.fr. Acres Width Dep[h <br /> Survey Submitted: Yes D� No Date of Survey: on� Fi(.t; <br /> Proposed Setbacks: <br /> Front (Lake): Right Side: <br /> Rear (Street): Left Side: <br /> Adjacent Structures: Wetland: N o C IfAw�,P � b-�< <br /> Building Hei�ht: Def. Hgt. Peak Hgt. <br /> Lot CoveraJe: <br /> Grading: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # — Resolution: /# Resolution Date: <br /> Shoreland District: y�5 <br /> Av�. Setback � ,�� Bluff Setback: n! �/� L.ocCovera�e: N•G• <br /> Eustin� Proposed <br /> Hardcover: 0-7�' <br /> 7�-250' N° <br /> 2�0-500' G�� <br /> 500-1000' <br /> Hardcover Variance Required: Yes No_� Date oF Council Approvai: <br /> REi�iAR�iS (in house): <br /> � <br />