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CHECK O�F LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 19 I (3 0�(�22 �2 <br /> PID: <br /> DESCRLPTION OF WORK: N�w �cS� <br /> - ----- ---- - ----__------------------- <br /> ZO�IG REVIE`V BY: �_ DATE APPROVED: 9 -�u-oy <br /> BUII.DI�i IG REV�`V BY: DATE APPROVED; R-�o -oy <br /> FEES TO BE CHA.RGED: Misc. Fees Calculated By: <br /> PERi1�IIT Yes ,/ No <br /> PLA�� REVIEW Yes �/ No SEWER CO�INECTION <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 /> ZONI�iG CHE.CK LIST zoning District: <br /> Fire Department: Post Office: School Dis[rict: • <br /> L,ot Area: Sq.ft. Acres Widch Depch <br /> Survey Submitted: Yes � No Date of Survey: g 'Z`�- O�{ <br /> Proposed Setbacks: <br /> Froat (Lake): y Right Side: � <br /> Rear (Street): v Left Side: Z <br /> Adjaceat Structures: q"T74G1t�—� �Vedand: I � � 5���`1� <br /> BuildinJ Hei�ht: Def. Hgt. 0.�� Peak Hgt. <br /> Lot Coveraoe: N �r4 <br /> Gradino: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: BY� <br /> Zoning File: # — Resolution: # Resolution Date: _ <br /> Shoreland Discrict: /UJ <br /> Avg. Setback: Bluff Setback: I.ocCoverage: <br /> Ezisting Proposed <br /> Hazdcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS (in house): <br /> 7 <br />