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� � CHECK OFF LIST FOR ISSU�'vCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: {��(� (,3�(� S S�� <br /> PID: <br /> DESCRIPTION OF WORK: W��.,�ow z,/�od�.s� sH-�LTd��f s/+'J,�� <br /> -----------_---------------------- ----- - --------------------------------- • <br /> ZONING REVIEW BY: DATE APPROVED• � /(I//� <br /> BUILDING REV�W BY: DATE APPROVED: �{- 2. -o c <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 WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZOti�G CHECK LIST Zoning Disuict: /V O G�-N4r�� <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres Widch 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: We and: <br /> Buildin� Hei�ht: Def. Ho[. Pe �Hgt. <br /> Lo[ Covera�e: <br /> Gradin�: Staff Approval Date: y: Council Approval Date: <br /> Septic: Staff Approval Date: y. <br /> Zoning File: # Resolution: # Resolution Date: <br /> Shoreland District: <br /> Av�. Setback: Bluff Setbac : L.ot Coverage: <br /> Existin� Proposed <br /> a <br /> Hardcover: 0-75' <br /> 75-2�0' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> RE�IARKS (in house): <br />