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CHECK O�`F i�IST FOR ISSU.ANCE OF �ERMITS <br /> ' FOR OFFICE USE ONLY <br /> .A_DDRESS OR LEGAL: I Zc�c� QRACK �.TS Po,�v� \Zo�D <br /> 1'11�: <br /> DESCRIPTIO�t OF WORK: Z,�, ��c� � ��n� <br /> ZO:�I�ti G RE'��4V BY: ----N l(� � DAT'E APPROVED: <br /> SUII.,DING REVI.EtiV BY: DATE APPROVED: 9 -rg-o� <br /> �EES TO BE CHA_RGED: Misc. Fees Catculated By: <br /> PERMIT Yes r� No <br /> PLAN REVIE�V � Yes ,/ No SEtiVE.R CONNECTION <br /> STATE SURCHARGE Yes � No WATFRCONNECTION <br /> INVESTIGATION FEE Yes No ,/ PARK FEE <br /> SAC Yes No �/ SITEINSPECTTON <br /> Number of SAC�Units OTHER (sgecify) <br /> -------------------------------------------- <br /> ZONi�tG CKE.CK LTST Zoning District: l'�/v Gf-fAN6 e , <br /> Fire Department: Post Office: School District: � <br /> I,ot Area; Sq.ft. Acres Width Pep� <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: . <br /> Froat(Lake): Right Side: <br /> Rear(S[reetj: Left Side: <br /> Adjaceat St:uctures: Wetland <br /> Builelin�Hei�it: Det. Hgt, Feal: gt. <br /> Lot Covera�e: <br /> Gradin�: S�aff�pproval Date: By: Council Approval Date: <br /> Septic: Stafr Approval Dace: �Y: <br /> Zoni.n� File: R Resolutioa: # Resolution Date: <br /> Shoreland District: <br /> Avg. Secback: Bluff Setback: Lot Covera�e; <br /> E�iscing Proposed <br /> H�rdcover: 0-75' <br /> ��-Zsa� <br /> Z�o-sao� <br /> soo-loco� <br /> E1�i�C0'��� �a'2'1ZIICA R�.^lU!1'C�: `:e5 ti:Q �3`.= OFCQ�IIlC� A�r.OV2�: <br /> F.E�L.=�RS�S (in house): <br />