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CHECK OFF LIST FOR ISSUA���CE OF PERMITS <br /> FOR OFFICE USE OiVLY <br /> ADDRESS OR LEGAL: �9�t F'A GL fZntESS �20� <br /> PID: <br /> DESCRIPTION OF WORK: K ►�-�t-�e� I���e�. <br /> ZOr�'G REV�W BY: DATE APPROVED: 5 �2-6'°n <br /> BUILDIYG REV�W BY: DATE APPROVED: ,s• z 6- o� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes _� No <br /> PLAN REVIEW Yes f No SEWER CONNEC"ITON <br /> STATE SURCHARGE Yes _� No WATERCONNECITON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> Z0�7Vi G CH�CK LIST Zoning District: �rv G <br /> Fire Department: Post Office: School District: <br /> L.at Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: <br /> Fron[(Lake): Right Side: <br /> Rear (Street): Left Side: <br /> Adjacent Structures: W land: . <br /> f <br /> , <br /> Building Height: Def. Hgt. Pe�Hgt. <br /> Lot Covera�e: <br /> V <br /> Grading: Staff Approval Date: B�y: Council Approval Date: <br /> Septic: Staff Approval Date: B�: <br /> k <br /> Zoning File: # Resolution: # ' Resolution Date: <br /> –�— <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 /> RENIARKS (in house): ��� <br /> , <br /> 7 <br />