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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 3'-1°i� (� r�c,r..F c,�NL <br /> ' PID: <br /> DESCRIPTION OF WORK: , , � , r <br /> Z0.�1Ivi G RE'VIEW BY: DATE APPROVED: /v• � -6 S <br /> BUII,D�G REVIEW B : DAT'E APPROVED: i � � � -0 5 <br /> FEES TO BE CHA.RGED: Misc. Fees Calculated By: <br /> PERMIT Yes � No <br /> PLAN REVIEW Yes �/ No SEWER CONNECITON <br /> STATE SURCHARGE Yes �/ No WATER CONNECTTON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ----------------------------------------------------------------------------------------------------------------------- <br /> Z0��1G CH�CK LIST Zoning District: <br /> Fire Department: Post O�ce: School District: <br /> Lot Area: Sc.ft. Acres Width Dep[h <br /> Survey Submitted: Yes_ c�_ I�10 Date of Survey: O�v f–r �F <br /> Proposed Se[backs: � <br /> Front (Lake): Right Side: (� <br /> Rear (Street): Left Side: <br /> Adjacent Structures: Wetland: <br /> Building Heiaht: Def. Hgt. Peal:Hgt. <br /> ���� Lot Covera;e: <br /> P ' <br /> N' Grading: Staff Approval Date: — By: Council Approval Da[e: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # — Resolution: # Resolution Date: <br /> Shoreland District: v.2S <br /> Av�. Setback: ��_� Bluff Setback: /�1 (�"r L.otCoverage: �,�L <br /> Ezistin� Proposed <br /> Hardcover: 0-75' <br /> 7�-250' 2 S <br /> 2�0-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No a Date of Council Approval: <br /> REI�IARKS (in house): <br /> � <br />