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• ' CHECK OFF LIST FOR ISSUAl�tCE OF PER1tiIITS <br /> _ FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: �,�cgp Go�r" T -s� �e �D R � <br /> PID: <br /> DESCRIPTION OF WORK: o o t. <br /> ZO�'G REV�`V BY: DATE APPROVED: � - ) - �� <br /> BUII.DI�i tG REVIE`V BY: DATE APPROVID: ci �'- na <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes �./� No :. <br /> pLAN REVIEW Yes � No SEtiVER 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 /> ZONI:vG CH�CK LIST zoning District: /t�- (� <br /> Fire Department: .v G4�� Post Office: (pi� �if�iv� School District: (�/l,oN� <br /> L,at Area: Sq.ft. ivv Gl�F�+^�p Acres — Width — Depth --- <br /> Survev Submitted: Yes � No Date of Survey: Qj-2�.-5 S <br /> Proposed Setbacks: <br /> Fron[ (Lake): �35� {' Right Side: 9 0 ' } <br /> Rear (Street): I�ig� '� Left Side: �`��� � <br /> Adjacent Structures: Zb� Wetland: "" . <br /> Buildin� Heigh[: Def. H;t. tiJ �d� Peal:Hgt. —' <br /> Lot Covera�e: — <br /> Gradin;: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zonin;File: # Resolution: # Resolution Date: <br /> Shoreland District: <br /> Av?. Setback: Bluff Setback: L.ot Covera?e: <br /> �'� Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> RE�IARKS (in house): <br /> 7 <br />