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� CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: Z,t 9� (,3,��rvi�w P�✓�c..c <br /> PID: <br /> DESCRIPTION OF WORK: 1/��,-z�� <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING REVIEW BY: sw� DATE APPROVED: 7• i • � � <br /> BUILDING REVIEW BY: DATE APPROVED: -,_ � -�z <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Yes ,/ No SEWER CONNECTION <br /> STATE SURCHARGE Yes �/ No WATER CONNECTION <br /> INVESTIGATION FEE Yes No �' / PARK FEE <br /> SAC Yes No ✓ SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING CH�CK LIST zoning District: <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. /7��/Z`'� Acres .Y Width Depth <br /> Survey Submitted: Yes� No Date of Survey: pr., <br /> Proposed Setbacks: <br /> Front (Lake): �� Right Side: ( 7 ` <br /> Rear (Street): 3t� � Left Side: 9 Y <br /> Adjacent Structures: — Wetland: — <br /> Building Height: Def. Hgt. � Peal: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 /> Shoreland District: �Y 5 <br /> Avg. Setback: ^//�} Bluff Setback: ,�///� Lot Coverage: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' I b •b� <br /> 250-500' 1 <br /> 500-1000' <br /> Hardcover Variance Required: Yes No � Date of Council Approval: <br /> REMARKS (in house): <br /> 7 <br />