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1 � CHECK OFF LIST FOR ISSUAI�ICE OF PERA�IITS <br /> ' FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 1 bc� r'�.-YiN r�,,� ���, <br /> PID: <br /> DESCRIPTION OF WORK: ���e ��,Or�t�-� <br /> ZO�'G REVIEW BY: DATEAPPROVED: G-3a-o3 <br /> BUILDING REVIEW BY: DATE APPROVED: G-3v-03 <br /> F'EES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ,� No <br /> pLAN REVIEW Yes ,/ No SEWER CONNECTTON <br /> STATE SURCHARGE Yes � No WATERCONNECTTON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No STTEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> --------------------------------------------------------------------------------------------------------------------- <br /> ZO�Ti�1G CHECK LIST Zoning District: <br /> Fire Department: Post Office: School District: <br /> Lo[Area: Sq.ft. Acres 1�Vidth Depth <br /> Survey Submitted: Yes�(_ No Date of Survey: Y'2-"'�°! <br /> Proposed Setbacks: <br /> Front (Lake): 3�� Right Side: �s <br /> Rear (Street): �i0' Left Side: �Sa <br /> Adjacent Structures: �� Wetland: `— <br /> Building Height: Def. Hgt. U•(< Peal:Hgt. <br /> Lot Coverage: U •K <br /> Grading: Staff Approval Date: -- By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # — Resolution: # Resolution Date: . . <br /> Shoreland District: �� <br /> Avg. Setback: Bluff Setback: I.ot Coverage: <br /> Existin; Proposed <br /> Hardcover: 0-75' <br /> 75-2�0' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> RE�ZARKS (in house): __ <br /> 7 - <br />