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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> � � FOR OFFICE USE ONLY <br /> � ADDRESS OR LEGAL: �f 3�S C i'f � PP L-tn1 vq t�4�v-2. <br /> PID: <br /> DESCRIPTION OF WORK: _ Co lt��r�r� A���, � __/n��s c � (J� (�"z.�' �rvn�,e <br /> ZO�1G REVIEW BY: DATE APPROVED: i b • �� - � � <br /> BUILDING REVIEW BY: DATE APPROVED: <br /> �_�_ �--- ____� <br /> ---- -------------------------------------------------- <br /> (o i.�.rc, � sn ��� y.hn✓Js t'�o G c.�:P_ <br /> FEES TO BE CHARGED• ~� ke�s Calculated By: <br /> PERMIT Yes � No <br /> PLAN REVIEW Yes No SEWER CONNECITON <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 /> ZOYI��G CH�CK LIST Zoning District: c� � <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: Wetland: <br /> Building Hei�ht: Def. Hgt. Peakll';Hgt. <br /> I <br /> Lot Covera�e: � <br /> Grading: Staff Approval Date: By:t Council Approval Date. <br /> I <br /> Septic: Staff Approval Date: By:� <br /> � <br /> Zoning File: /# Resolution: # �Resolution Date: <br /> I <br /> Shoreland District: <br /> Avg. Setback: Bluff Setback: L.ot Coverage: <br /> Ezisting � Proposed <br /> Hardcover: 0-75' ! <br /> 75-250' �`; <br /> 2�0-500' � <br /> 500-1000' �� <br /> I <br /> Hardcover Variance Required: Yes No I Date of Council Approval: <br /> RENLARKS (in house): � _ <br /> 7 <br />