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' � CI3ECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESSORLEGAL: SU� �GRNIpAIrE 2oA(J N�R�1� <br /> PID: <br /> DESCRIP'I'ION OF WORK: yYIDYL" �02�v�w�4y , ,4�0 +3cRr+� - c�c� c���c �,a2o S <br /> ZONING RE'VIEW BY: � DATE APPROVED: 1-Z3-�7 <br /> BUILDING REVIEW BY: �_ DATE APPROVED: �.L3-57 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT — C�2�A h�N 5 Yes x No <br /> PLAN REV�W Yes No SEWER CONNECITON <br /> STATE SUR`HARG�� Yes No WATER CONNECITON <br /> INVESTIGAZ'ION-FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> �ONlNG CHECK LIST Zoning District: <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.fr. Acres Width Depth <br /> Survey Submitted: Yes No�_ Date of Survey: <br /> SITC PW� DNl..4 <br /> Proposed Setbacks: � <br /> Front (Lake): . Right Side: <br /> Rear (Street): Left Side: <br /> Adjacent Structures: Wetland: <br /> BuIlding Height: Def. Hgt. Peak Hgt. <br /> Lot Coverage: <br /> Grading: Staff Approval Date: "1-�.q g'? By: ��. Council Approval Date: f/�� • <br /> i —�� ���' � <br /> Septic: Staff Approval Date: "', By:y�'� <br /> Zoning File: # Resolution: # Resolution Date: <br /> Shoreland Dis�ict: <br /> Avg. Setback: Bluff Setback: Lot Coverage: <br /> � Ezisting 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 /> REMARKS (in house): <br /> • 26 . <br />