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�HECK OFF i.IST FOR ISSUANCE 4�F PE��IITS <br /> FOR OFFTCE USE ONLY <br /> ADDRESS OR LEGAL: �G��ZC� -Fc>/� <br /> PID: <br /> DESCR�i�IO�i OF WORK: r�f/�m i�� � ��'� S� <br /> --- -----------____--_------------------- <br /> -----------------------------------------� <br /> ZO.�i G REVIEtiV BY: E'�� DATE APPROVED: Z�v C /�' <br /> SULLDING REVIE`V BY: ,v /� DATE AP'PROVED: <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMiT Yes No <br /> PLAN REVIE`V Yes No SE�VER CONNECTION <br /> STATE SUR.CHARGE Yes No `VATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZO��IG CH�CK LIST Zoning Districr. _ . <br /> Fire Department: Post O�ce: School District: <br /> I,ot Area: Sq.ft. Acres Widch _ Depth <br /> Survey Submit[ed: Yes No Date of Survey: <br /> Proposed Setbacks: �1� . <br /> Front (Lake): Righ[Side: <br /> Rear (Street): Left Side: _ <br /> Adjacenr Srn,ctures, Wetland: <br /> Suil�ling Hei�[: Def. Hgt. Peal:Hgt. <br /> Lot Covera�e: <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: � �Y� _�� <br /> Zoaing File: � Resolutioa: � Resolution Da[e: <br /> Shoreland Dis[rict: <br /> Avg. Se[back: Bluff Setback: I.o[Coverage: <br /> E�istinQ Proposed <br /> 0 <br /> Hardcover: G-7�' <br /> 7�-250' <br /> 2�0-500' <br /> 500-1000' <br /> H��dco��er Variance Rzquired: Yes No Da�e of Council Approval: <br /> �E�L4RkS (in house): <br />