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� � ' �HEC� OFF i.�IST FOR ISSUANCE OF PERNIITS <br /> - FOR OFFICE USE ONLY <br /> � ADDRESS OR LE%AL: Z i Zo �o X sT - <br /> T.'ID: <br /> DESCRIP'TI41I OF WORK: oo � <br /> ZOYI�IG REVIE`V BY: ---��. DATE APPROVED: —7- Z�- a 4- <br /> $U]ZDII�IG REVIEtiV BY: DATE APPROVED: �- �-o-� <br /> FEES TO BE CHARGED: � Misc. Fees Calculated By: <br /> PERMIT Yes No <br /> PLAN REVIEW � Yes _� No SEtiVER CONNECTION <br /> STATE SURCHARGE Yes _� No WATERCONNECTION <br /> INVESTIGATION FEE Yes No t/ PARK FEE <br /> SAC Yes No � STTEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZONI�IG CT:i�CK LIST Zoning Discricr. �. <br /> Fire Department: Post Office: School District: � <br /> Lot Area: Sq.ft. Acres Widch Depth <br /> Survey Submitted: Yes �_ No Date of Survey: 0�.1 1�l � <br /> Proposed Setbacks: <br /> Front(Lake): Right Side: <br /> CX �� ��^� <br /> Rear (S[reet}: Lef:Side: <br /> Adjacea[ Structures: Wetland: <br /> Building Height: Def, Hgt. ^� �/A Peal:Hgt. <br /> Lot Covera�e: n��� <br /> Grading: Staff Approval Date: � By: Council Approval Date: ' <br /> Septic: Staff Approval Date: � �y� <br /> Zoain� File: n ` Resolution: # Resolution Date: <br /> Shoreland District: 0�`� <br /> Av�. Setback: $luff Secback: Loc Coverage: <br /> E�istin� Proposed <br /> 0 <br /> Hardcover: 0-75' <br /> 75-250' <br /> 2�0-500' <br /> 50a-100fl' <br /> Ha:dcover Va;iance Required: Yes No Da�e of Council Approvz!: <br /> R.E�L�S (in house): <br />