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�TiEC�K OFF i,IST FOR ISSUANCE O�F PER.i1�IITS <br /> � FOR OFFTCE USE ONLY <br /> ADDRESS OR LEGAL: 1 S�U G��T��S -- <br /> PID: <br /> DESCRIPTION OF WORK: New CJc����6 * �"- oN ��c� 'r'^`�` "4'`-� <br /> ZON�i IG REVLE`V BY: --- — ----_._-_" DATE APPP.OVED: g�2 Y -�-6 <br /> BLIII�DING REVTE�V BY: DAT'E APPROVED: �g•Ly -a t <br /> FEES TO BE CHA.RGED: Misc. Fees Calculated By: <br /> PERMIT Yes � No <br /> PLAN REVIE`V � Yes No ,/ S�VE.R COVNECTION <br /> STATE SURCHARGE Yes _� No `VATERCONNECTTON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZOY�tG C�CK LIST Zoning District: �� Gc�,�c� . <br /> Fire Department: Post Office: School District: <br /> L,ot Area: Sq.ft. Acres idth Depth <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: . <br /> Front(Lake): Right Side: <br /> Rear (Street): Left Side: <br /> Adjaceat Structures: W tland: <br /> Buildin� Hei�it: Def, Hgt, Pe • Hgt. <br /> Lot Covera�e: <br /> Grading: Staff Approval Date: y: Council Approval Date: ' <br /> Septic: Staff Approval Date: �� <br /> Zonin� File: � Resolution: � Resolution Date: <br /> Shoreland Distric[: <br /> Av�. Setback: Bluff Secba : I.ot Coverage: <br /> E�istin� Proposed <br /> a <br /> Hardcover: 0-75' <br /> 75-250' <br /> 2�0-500' <br /> 500-1000' <br /> Hardco��er Va:iance Required: Yes No Da�e oE Council Approvzl: <br /> �E��LARKS (in house): <br />