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'. � CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: s Z 5 C 2c 57v�c.=�,.� A-��' <br /> PID: <br /> DESCRIPTION OF WORK: ��,�ts�,,,�� P�:�� <br /> ZOrTvi G REVIE`V BY: DATE APPROVED: 5- / 7- � �� <br /> BUII�DING REVIE`V BY: DATE APPROVED: s�,� -�5 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes t/ No <br /> PLAN REVIEW Yes � No SEWER CONNECTION <br /> STATE SURCHARGE Yes _�/ No WATERCONNECTION <br /> INVESTIGATION FEE Yes No ;i PARK FEE <br /> SAC Yes No � SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> --------------------------------------------------------------------------------------------------------------------- <br /> ZOr�i G CH�CK LIST Zoning District: <br /> Fire Departmenr. Post O�ce: School District: <br /> Lot Area: Sq.ft. Acres Widch Depth <br /> Survey Submitted: Yes X No Date of Survey: Jiv �=�� j G -�b•�3 <br /> Proposed Setbacks: <br /> Front (Lake): ��� = Right Side: Z�� 5 <br /> Rear (Street): ZZ' t Left Side: `�y� ^' <br /> Ad;acent Structures: i o � Wetland: nr/r4 <br /> Building Heioht: Def. Hgt. �'V�f} Peal:Hgt. — <br /> Lot Covera�e: �/ �,q - rv�� ci�lv�,�Jr�,t <br /> Grading: Staff Approval Date: ,S-/� �� By: �U Council Approval Date: <br /> Septic: Staff Approval Date: ,a//� By: <br /> Zoning File: # — Resolution: # — Resolution Date: <br /> Shoreland District: 5 <br /> Avg. Setbac : �v/� Bluff Setback: ��oQ L.ot Coverage: — <br /> Ezisting Proposed <br /> Hardcover: 0-75' <br /> 7�-250' <br /> 2�0-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS (in house): <br /> 7 <br />