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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESSORLEGAL: �-(3ss Cti�,�%�,q L,4n� <br /> PID: <br /> DESCRIPTION OF WORK: (,�a�rpi,�� p,.�,r� �-;-r�,/L <br /> _—____________--------------------- ------------------------------------------- <br /> ZOr1�i G REVIEW BY: � DATE APPROVED: i z�1 z-� � <br /> BUII..DING REVIE`V BY: DATE APPROVED: �Z-i z-� � <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PER1v1IT Yes �/' No <br /> PLA��1 REVIEW Yes ��o SEWER CONNECITON <br /> STATE SURCHARGE Yes (/ No WATERCONNECITON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No STTEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING C�CK LIST zoning District: No G���� Y K�1 (�4��.v'�c /-� s�/� <br /> I S /`) NbN ls�C/fiDA G l�ry� <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: Wedand: <br /> Building Height: Def. Hgt. Peal:Hgt. <br /> Lot Covera?e: <br /> Grading: Staff Approval Date: By: Council Approv Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File: # Resolution: # Resolution Date: <br /> Shoreland District: <br /> Avg. Setback: Bluff Setback: L,ot Cove ge: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Vaziance Required: Yes No Date of Council App oval: <br /> RE1I�IARKS (in house): <br /> 7 <br />