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� + CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESSORLEGAL: I `11",� F,o,c,�.ca cv�,ss ���iNT 2oAr� <br /> PID: <br /> DESCRIPTION OF WORK: Z,vrg s-r-�,R,�-, ,�r�,o,.r ,�rJ <br /> ZO�TG REVIEW BY: DATE APPROVED: �-L�-uz <br /> BUII�DI�tG REV�W BY: DATE APPR4VED; �{-2.7-u Z <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes c/ No <br /> PLAi�1 REVIEW Yes � No SEWER CONNECITON <br /> STATE SURCHARGE Yes c/ No WATER CONNECITON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CH�CK LIST Zoning District: <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes_� No Date of Survey: -1 -9� <br /> Proposed Se[backs: <br /> F�e�t (Lake): � Z S� '�' Right Side: Z�'. ��"`'� <br /> F�e�(Street): 6�/� Left Side: 36� { <br /> Adjacent Structures: N �r/1 `Vettand: �/l/� <br /> Building Height: Def. Hgt. (�• 1c Peal:Hgt. D�/� <br /> Lot Coverage: -` <br /> Grading: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # l�z-Z�?�j Resolution: # Resolution Date: `1-Z Z-�2 <br /> Shoreland District: y e� <br /> Avg. Setback: �.l� Bluff Setback: �J//�- L.ot Coverage: /� /� <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> �s-2so� No C I�G e <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No ;� Date of Council Approval: <br /> REMARKS (in house): � �,�c��".`� ��'6/��:�'�' � <br /> � <br /> 7 <br />