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� CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: i `-(�; �� C'--��7-���� C.��t.c.Z=:��� _ <br /> PID: <br /> DESCRIPTION OF WORK: ��,�� ;, -_`� <br /> -----_____________ _ ___�----------- 4 <br /> ZO�'G RE'VIE`V BY: .� �,. % �v DATE APPROVED: L 7- �`� <br /> BUILDTi�'G REVIEW BY: �" •� 'r DATEAPPROVED: � z7 -`7 i <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes (,/ No <br /> PLAN REVIEW Yes ✓ No SEWER CONNECITON <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 /> ----------------------------------------------------------------------------------------------------------------------- <br /> ZONING CH�CK LIST Zoning Districr. 1�f�- 1('� <br /> Fire Department: l.c_��ic-i; Post Office�.-t:.vt.,`.�-,�_ School District: c�.��x%� <br /> Lot Area: Sq.fr. Acres ? }��`„e� :t- Width ;�'��-�=�:�-�-''n'� Depth <br /> Survey Submitted: Yes „` No Date of Survey: <br /> Proposed Setbacks: � <br /> Front(Lake): ��• � Right Side: `7'Lj� � <br /> Rear (Street): I��` Left Side: � � �1 V <br /> Adjacent Structures: /� � 1� Wetland: � <br /> Building Height: Def. Hgt. L3 Peal:Hgt. �� <br /> Lot Coverage: ti (r°�- <br /> Grading: Staff Approval Date: �-� ? ' �`( By: -��-% Council Approval Date: �" <br /> Septic: Staff Approval Date: �� � Z�1 �4� By: �L�-% <br /> Zoning File: # -- Resolution: # �� Resolution Date: --- <br /> Shoreland District: ��� <br /> Avg. Setback: Bluff Setback: L.ot Coverage: <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 /> REMARKS (in house): <br /> 7 <br />