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. , � <br /> � CHECK OFF LIST FOR ISSUAl�tCE OF PER1v1ITS <br /> - FOR OFFICE USE ONLY <br /> ADDRESS ORLEGAL: � Sc� (��Z.piv o C�(ZC.1�-�C� � <br /> PID: <br /> DESCRIP'TION OF WORK: �(�p�n/(� <br /> - _____�__ <br /> ZO�'G REV�`V BY: W DATE APPROVED: $ • Z f3 - C�v <br /> BUII.DING REVIEtiV BY: sv /� DATE APPROVID: <br /> c.� �� `�'/o • �°. <br /> FEES TO BE CHARGED: �,��NS isc. Fees�Calculated �y: c� � <br /> PERNIIT Yes � No ; <br /> PLAN REVIEW Yes No SER�CONNECTION <br /> STATE SURCHARGE Yes No WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No STTEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZONI:�tG CH�CK LIST Zoning Districc: /l�o G ���� _ <br /> Fire Department: Post Office: School District: <br /> L,ot Area: Sq.fr. Acres idch Depch <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Se[backs: <br /> Fron[ (Lake): Right Side: <br /> Rear (Street): Left Side: <br /> Adjacent Structures: `Ve land: <br /> Buildin, Heiaht: Def. Hgt. Pe �Hgt. <br /> Lot Covera�e: <br /> Gcadin;: S�aff Approval Date: y: Council Approval Date: <br /> Septic: Staff Approval Date: y: <br /> Zoning FIle: 1# Resolution: # Resolution Date: <br /> Shoreland District: <br /> Av�. Setback: Bluff Setbac : L,ot Covera�e: <br /> ExistinQ Proposed <br /> a <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> RE�L�RKS (in house): <br /> 7 <br />