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r � . <br /> CHECK OFF LIST FOR ISSUANCE OF PEItMITS <br /> FOR OFFICE USE ONLY <br /> A.DDRESS ORLEGAL: 1 �5 �1/ . r��2N fJALE � <br /> PID: <br /> DESCRIPTION OF WORK: �p,�v ' -r�YtA-n�� o <br /> - ZO.vI�ti G REVIE�V BY: -�- G3•v . DATE APPROVED: 1- � �� -o � <br /> BUII.DING REVIE`� BY: DATE APPROVED; <br /> FEES TO BE CHARGED: MiNi2 I�I��Fy LL�a�'culated$y: <br /> I isc. ees <br /> PERNiIT Yes � No <br /> PLAN REVIEW Yes No SEWER COiVNECITO�' <br /> STATE SURCHARGE Yes No WATERC0�INECITON <br /> INVESTIGATION FEE � Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZONP1i G CH�CK LIST Zon.ing Districr. iv-o c f+�,p . <br /> Fire Department: Post O�ce: School District: • <br /> Lot Area: Sq.ft. Acres � Width Depth <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: � <br /> Fron[(Lake): Right Si e: <br /> Rear (Street): Left Sid : <br /> Adjacent Structures: �Vetland: <br /> Building Height: Def. Hgt. Peal:Hgt. <br /> Lot Coveraje: <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: L.ot Covera�e: <br /> Ezisting Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-SQO' <br /> 500-1d00' <br /> Hardcover Variance Required: Yes No Date of Council App:oval: <br /> REI�L�RKS (in house): _ �. <br /> � . . <br />