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�HEC� OFF i,IST FOR ISSUANCE OF PE�'VIITS <br /> . FOR OFFICE USE ONLY <br /> A.DDRESS OR LEGAL: 9 5 t=�2N O W�.� C��"t,�—c_.w <br /> PID: <br /> DESCR�'TION OF WORK: 12� �n���=Z �w`'�- �-�v�-t <br /> ZOYI�IG REVIEtiV BY: DAT`E APPROVED: <br /> SUILDIi�IG REVTEtiV BY: DAT'E APPROVED: 0� �b-o� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes � No <br /> PLAN REVIE`V � Yes � No SE`VER CONIVECTION <br /> STATE SURCHARGE Yes c/ No WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC�Uruts OTHER (specify) <br /> ---------------------------------------------------------------------------------- <br /> ZONi�tG CHE.CK LIST Zoning District: �V� G��-��- �' <br /> Fire Deparcment: Post Office: School District: � <br /> Lot Area: Sq.ft. Acres Wid[h Depth <br /> Survey Submicted: Yes No Date of Survey: <br /> Proposed Setbacks: <br /> Froat (Lake): Ri� Side: <br /> Rear (Stree[): Left ide: <br /> Adjacea[ Structures: Wetland: <br /> Buil�lin� Hei�t: Def. Hgt. Peal:Hgt. <br /> Lot Covera�e: <br /> Gradino: Staff Approval Date: By: Council Approval Date: ' <br /> Sep�ic: 5taff Approval Da[e; BY: <br /> Zoaing File: � Resolution: Resolution Date: <br /> Shoreland District: <br /> Av�. Setback: Bluff Se back: Lot Covera�e: <br /> E�istin Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 2�0-540' <br /> 500-1000' <br /> I-ia�dcoti'er Va:iance Required: Yes No Da�z of Council Approv�: <br /> �n,o,o o S�� <br /> R.E`L4R�iS (in house): G 6�S G�ec.L rvt.c:zs 7-- s�✓��s .s� �/�G/� <br />