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�►�- '� <br /> . CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: q �c� W . ��R N p A�•l� 6'�-0� <br /> PID: <br /> DESCRIPTION OF WORK: f2�-�vq,rv� w a��.� <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING REVIEW BY: DATE APPROVED: � - s . v D <br /> BUILDING REVIEW BY: DATEAPPROVED: G . s-v� <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes � No <br /> PLAN REVIEW Yes _� No �' SEWER CONNECTION <br /> STATE SURCHARGE Yes �� No WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING CHECK LIST zoning District: iv� c f-f-A-r��( <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: <br /> Front (Lake): Right Side <br /> Rear (Street): Left Side: j <br /> Adjacent Structures: Wetland: <br /> Building Height: Def. Hgt. Peal:Hgt. <br /> Lot Coverage: ! <br /> Grading: Staff Approval Date: �-S-�� By: �U. Council Approval Date: <br /> Septic: Staff Approval Date: — II gy: <br /> Zoning File: # Resolution: # Resolution Date: <br /> Shoreland District: y�t S <br /> Avg. Setback: c�• I� Bluff Setback: N i�= Lot Coverage: — <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' � <br /> 250-500' <br /> 500-1000' i <br /> Hardcover Variance Required: Yes Nq Date of Council Approval: <br /> REMARKS (in house): <br /> 7 <br />