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, � . <br /> � • <br /> � CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: /y 7_ c::H�V�j C tt��s� �►,�'� <br /> PID: <br /> DESCRIPTIOIV'OF WORK: �r���r <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING REVIEV�J BY: � � ,,� DATE APPROVED: t o -Z?-ti:� <br /> BUILDING REVIEW BY: - r � t DATE APPROVED: t c� � t7- �'� <br /> -------------------------------------------------=t ------------------------------------------------------------------- <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes t/� No <br /> PLAN REVIEW Yes r/' No SEWER CONNECTION <br /> STATE SURCHARGE Yes � No WATER CONNECTION <br /> INVESTIGATION FEE Yes No c� PARK FEE <br /> SAC Yes No �.--( SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> -------------------=--------------------------------------------------------------------------------------------------- <br /> ZONING CHECK LIST Zoning District: �'�.-�� <br /> Fire Department: w T A�t-n Post Off ce: t,�;R-��--�-Y� School District: c.,�;,4-t,��,�-Ty� <br /> Lot Area: Sq.ft. 2`���S�7 Acres � (�;� Width ��CJ Depth ��l� <br /> Survey Submitted: Yes �. No Date of Survey: i G • 2 � -�i � <br /> Proposed Setbacks: <br /> Front (,ba�: t�Z r t Right Side: �� 1 <br /> Rear (St�ee�): C,�� {= Left Side: �l? � <br /> Adjacent Structures: /� � Wetland: �t!/r� <br /> Building Height: Def. Hgt. Peak 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 /> Y- Shoreland District: <br /> Avg. Setback: Bluff Setback: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> SJO-lOOO' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS (in house): <br /> 10 <br />