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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 1 l Z O G o x r—P.Rrn 2aA� <br /> PID: <br /> DESCRIPTION OF WORK: Q,AS�.M�NT �'� ,v�sc-� <br /> ZOr11i iG REVIEW BY: N I DATE APPROVED: <br /> BUII..DTivG REV�`V BY: DATE APPROVED: �o - �- u z <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes ✓ No <br /> PLA��1 REVIEW Yes ,/ No SEWER CONNEC"ITON <br /> STATE SURCHARGE Yes ✓ No WATERCONNECTTON <br /> INVESTIGATION FEE Yes No ✓ PARK FEE <br /> SAC Yes No � SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZO1VTi 1G CH�CK LIST Zoning District: /VU �-�f�v 6� <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres Wi th Depth <br /> Survey Submitted: Yes No te of Survey: <br /> Proposed Setbacks: <br /> Front (Lake): Right Side: <br /> Rear (Street): Left Side: <br /> Adjacent Structures: �Vetland: <br /> Building Hei?ht: Def. Hgt. Pealc Hgt. <br /> Lot Covera;e: I <br /> Gradina: Staff Approval Date: By: I Council Approval Date: <br /> � <br /> Septic: Staff Approval Date: By: � <br /> i <br /> Zoning File: # Resolution: # Re�olution Date: <br /> Shoreland District: <br /> Avg. Setback: Bluff Setback: � L.ot Coverage: <br /> Existing � Proposed <br /> Hardcover: 0-75' i <br /> 75-250' ' <br /> 250-500' � <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> RENIARKS (in house): � <br /> 7 <br />