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CHECK OFF LIST FOR ISSUANCE OF PERVIITS <br /> FOR OFFICE USE ONI,Y • <br /> ADDRESS OR LEGAL: j y(�� �3�,(�w s (�� I N T l20,�..,� <br /> PID: <br /> DESCRIPTION OF WORK: ��se-c�v.�- u r�-e1 E=X�s z1�•,t� 0 2 T-t o.v U u s-Q <br /> ZOrTti'G REVIEtiV BY: DATE APPRO«D: �- 3 -c�o <br /> BL'II..DL,1G REY�`V BY: DATE APPROVED; Z � 3 - �J <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes � No <br /> pI,AN REVIEW Yes � No SEtiVER CO�'EG"ITON <br /> STATE SURCHARGE Yes U-- No �VATERCOi�1�'ECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEL�TS'PECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZO`Z`�G CH�CK LIST zoning Districr. Y� C ft��� �. . <br /> Fire Depar[ment: Post Office: School Dsuict: � <br /> Lot Area: Sq.ft. Acres � Width Depth <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: <br /> Front(Lake): Ri�ht Side: <br /> Rear (Street): I.eft Side: <br /> Adjacent Structures: tiV tland: _ <br /> Building Hei�ht: Def. Hgt. P al:H?t. <br /> Lot Covera�e: ' <br /> Gradin�: Staff Approval Date: By: Council Appro�-�1 Date: <br /> Septic: Staff AFproval Date: By: <br /> Zoain�File: # Resolution: # Resolution Date: <br /> Shoreland District: <br /> Av�. Setback: Bluff Se ack: L.ocCo�9ra�e: <br /> Ezistmg Progosed <br /> Hardcover: 0-7�' <br /> 75-2�0' <br /> 2�0-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date o`Counci? Approval: _ <br /> RE�LARIiS (in house): <br /> 7 <br />