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t ' CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: �SS �=o c�r �4-/Lc� S L�-� <br /> PID: <br /> DESCRIPTION OF WORK: N G W Qn�� ,/�.� ,�r-r�-vc � r� �J c-c-�� <br /> ZOr1�i G REV�`V BY: DAT'E APPROVED: 6-/S •oS <br /> BUII.DING REV�`V BY: DATE APPROVED: 6-�5 -o� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes �/ No <br /> PLAN REVIEW Yes � No SEWER CONNECI'ION <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 /> ZO�G CH�CK LIST Zoning Districr. <br /> Fire Department: Post Office: Schooi District: <br /> Lot Area: Sq.ft. Acres �Vid[h Depth <br /> Survey Submitted: Yes �l No Date of Survey: oN t=�c�"c <br /> Proposed Setbacks: Po.l O�c.� (�••< <Oc�vc <br /> Front (Lake): 2�r y'_' z�3 � Right Side: ,5 Si � ''- <br /> Rear (Street): `Go' # 63 1 Lef[Side: 7u ' l3� y <br /> Ad;acent Structures: (U' Wetland: µ/ /,�Q <br /> Buildin; Height: Def. Hgt. N /� Peak Hgt. <br /> Lot Covera�e: /V�� c r�r�w.,�,R <br /> Grading: Staff Approval Date: — By: '-' Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zon.in, F:le: # — Resolution: # Resolution Date: <br /> Shoreland District: ��5 , <br /> Avg. Setback: c�•�� Bluff Setback: /v�� L.ot Covera;e: <br /> Eusting Proposed <br /> Hardcover: 0-7�' <br /> 7�-250' p,� <br /> 25a-500' 30"�� <br /> 50a-1000' <br /> Hardcover Variance Required: Yes No >C Date of Council Approval: <br /> RE�iAR�iS (in house): <br /> � <br />