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� CHECK OFF LIST FOR ISSUAI�ICE OF PERMITS <br /> , FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: ( q 13 l=/�GL,R rv�S �O trvT (�A�✓� <br /> PID: I(,�-I I"1 -Z 3 I`-i c�o 0 4� <br /> DESCRIPTION OF WORK: ��2��;,(�,S + �v L(� �nr Cn.4/lhG� <br /> ZOrTvi G REV�W BY: DATE APPROVED: �-3-n I <br /> BUII�DING REVIE`V BY: DATE APPROVED: 1 - 3-v c <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes ✓ No <br /> PLA��1 REVIEW Yes � 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 /> Z0��1G CH�CK LIST Zoning District: G/Z-� C.. <br /> ire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres Width Dep[h <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: <br /> �p Fron[ (Lake): Right Side: <br /> � Rear (Street): Left Side: <br /> L <br /> Adjacent Structures: �Vetland: <br /> Building Hei�ht: Def. Hgt. Peal:Hgt. <br /> Lot Coverage: <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File: # 2 66�j Resolution: # Resolution Date: (�-1( —c� � <br /> Shoreland District: <br /> Avg. Setback: Bluff Setback: Lot Coverage: <br /> �u Existing Proposed <br /> � Hardcover: 0-75' <br /> 75-250' <br /> �k 250-soo' <br /> � soo-i000� <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REil�1ARKS (in house): <br /> 7 <br />