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CHECK OFF LIST FOR ISSUAz��CE OF PER11�fITS <br /> _ � FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: ��,�� �.P��/� c��+ I�-� � <br /> PID: <br /> DESCRIPTION OF�ORK: -2� � <br /> . <br /> ZO�'G REVITT`� BY: DATE APPROV�D: �� - � 7 -cx� <br /> BUII..DING REV�tiV B . Y�c�,v�s. DATE APPROVID: ,/O�1�� <br /> FEES TO BE CH.4RGED: Niisc. Fees Calculated By: <br /> pERMIT Yes �_ No : <br /> pLAN REVIEW Yes 1c No SER�R CONNECTION <br /> STATE SURCHARGE Yes X No WATERCONNECTION <br /> IIr'VESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECITON <br /> Number of SAC�Units OTHER (specify) <br /> Z011I.11G CH�CK LIST zoni.ng District:�2./� -`� N <br /> Fire Deparcment: `n < Post Office: !��'1� �� School District: � Z 7� <br /> Lot Area: Sq.ft. No cc.r,�.� Acres Widch Depth <br /> Survey Submitted: Yes�_ No Date of Survey: '� <br /> Proposed Setbacks: <br /> Fron[ (Lake): Z`t�� '� Rioht Side: �IS � � <br /> i � <br /> Rear (Screet): 39 Z � �- Left Side: 2–�'Y <br /> Adjacent Structures: 1 b � Po� l Wetland: N /� � <br /> Buildin� Hei?ht: Def. H�t. — Pea�:Hgt. — <br /> Lot Covera�e: " <br /> Gradin;: Scaff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: --- By: <br /> Zoain;File: # t�' Resolution: � Resolution Dace: <br /> Shoreland District: �� <br /> Av�. Setback: Blufi Setback: L.otCovera�e: <br /> Ezis�inQ Proposed <br /> � <br /> Hardcover: 0-75' <br /> 75-250' <br /> ti0-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> �tE�IA,RKS (in house): <br /> 7 <br />