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CHECK OFF LIST FOR ISSUAN E OF PERMITS <br /> ' FOR OFFICE USE O LY <br /> ADDRESS OR LEGAL: �' y �y S�rJ� !'�/� <br /> PID: <br /> DESCRIPTION OF WORK: ,5+-��� <br /> - -____ _-- _ -------------------------- --------------------- - ---- -- - <br /> Z0.�1I�i IG REVIEW BY: � DATE APPROVED: 6- Z-�Y <br /> BUII�DI�i 1G REV�W BY: _ DATE APPROVED; � -G� <br /> FEES TO BE CHARGED: Misc. Fees alculated By: <br /> PERMIT Yes �/ No <br /> PL?,i�T REVIEW Yes ;,/ No SEWER CONNECITON <br /> STATE SURCHARGE Yes _;� No WATERCONNECTTON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No STTEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZONING CHE.CK LIST Zoning District: <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes r� No Date f Survey: c�iv ���t' <br /> Proposed Setbacks: <br /> Front (Lake): ZS�' �* Right Side: i v�` <br /> Rear (Street): �5 ` Left Side: i 5�� <br /> Adjaceat Structures: 7v� � �Vetland: f/� <br /> Building Hei�ht: Def. Hgt. v� �- Peal:Hgt. ��� <br /> Lot Coverage: N � /g <br /> Grading: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: ' By: <br /> Zoning File: # — Resolution: # Reso ution Date: <br /> Shoreland District: /vU <br /> Avg. Setback: Bluff Setback: L,ot Coverage: <br /> Existing 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 /> RENIARKS (in house): <br /> 7 <br />