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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: �S S ��G�c y c�� ���v c <br /> PID: <br /> DESCRIPTION OF WORK: ►a p,l��T i o r•l i <br /> ----------------------------------------3---- <br /> ZO�Ti 1G $E'VIEW BY: �Qu J� (Qa,,,,Q,,,,_ ----~- DATE APPROVED: Z-z Y-o <br /> BUII.,DI1i tG REVIEW BY: .� � _,._ DATE APPROVED; z.ZY_03 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PER�IiiIT Yes ✓� No <br /> PLA��1 REVIEW Yes v' No SEWER 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 /> ZO�TING CH�CK LIST Zoning District: <br /> Fire Department: Post Office: School District: � <br /> Lot Area: Sq.ft. Acres Width Depch <br /> Survey Submitted: Yes_� No Date of Survey: pnr c=�� S-2� • g3 <br /> Proposed Setbacks: <br /> Front (Lake): I l°t.�`1 Right Side: �f�•�� <br /> Rear (Street): ��� -�- Left Side: ��' f' <br /> Adjacent Structures: /�-rr-r+cF�-=-'� Netland: N/✓3- <br /> Building Height: Def. Hgt. c�•l� Peal:Hgt. <br /> Lot Covera�e: — <br /> Grading: Staff Approval Date: '�" By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # — Resolution: # Resolution Date: <br /> Shoreland District: /V`� <br /> Avg. Setback: Bluff Setback: L.ot Coverage: <br /> Ezisting 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 /> RENiARKS (in house): <br /> 7 <br />