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CHECK OFF LIST FOR ISSUA.��'CE OF PER1tiIITS <br /> _ � � FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 2Z.�-1 C� F t�� S<«�_—` <br /> PID: <br /> DES CRIPI�I ON OF W ORK: � (1}�(J(rv Co (�J:c,o c�Z '�2-``��"�-- <br /> � _^- ---- -- <br /> ZO�TG REVIE`� BY: DATE APPROVED: <br /> BUII,DING REY�ti� BY: �v � � DATE APPROVED: <br /> CofLk+>��Jc w(c� <br /> FEES TO BE CH.4RGED: Misc. Fees Calculated By: <br /> pERMIT Yes � No � <br /> pLAN REVIEW Yes No SEWF�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 /> � ZONI:�G CHE.CK LIST Zoning District: _ <br /> G� Fire Department: Post Office: School District: � <br /> t Area: Sq.ft. Acres Width Depth <br /> Surve;� Submitted: Yes oc. No Date of Survey: Z - Z-�e�6 <br /> Proposed Setbacks: <br /> Fron[(Lake): Right Side: <br /> Rear(Screet): Left Side: �� �� <br /> Adjacent Structures: �Vetland: � . <br /> Buildin� Heioht: Def. H�t. Peal:H�c. <br /> Loc Covera�e: <br /> Gradin�: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File: # Resolution: # Resolution Date: <br /> W'� Shoreland District: <br /> Av'. Setback: Blufi Setback: LotCovera�e: <br /> EzistinQ Proposed <br /> � <br /> Hardcover: 0-75' <br /> 75-250' <br /> ti0-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> I�IAR]KS (in house): <br /> 7 <br />