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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> . FOR OFFICE USE ONLY <br /> ADL�RESS OR LEGAL: y 0 S 1 N t�t-1 W oo�J �Zo� <br /> PID: <br /> DESCRIPTION OF WORK: uP�A�:_oRit,�,v,,9�c. �,� � f���a� vn/D/1'72 fN �+N���`'�: <br /> ------���__�_—______�_�r��_____------------------------------------------------------------ �-+u.>S--P <br /> ZOr`IYG RE'VIE`V BY: DATE APPROVED: y�Z J-o S <br /> BUILDING REVIE`V BY: �� �Q�..w.._ DATE APPROVED: y- Z, _bs <br /> �. <br /> FEES TO BE CHA.RGED: Misc. Fees Calculated By: <br /> PERNIIT Yes � No <br /> PLAN REVIEW Yes No �/ SEWER CONIVECI'ION <br /> STATE SURCHARGE Yes r/ No WATER CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ---------------------------------------------------------------------------------------------------------------------- <br /> ZO�IIIIG CH�CK LIST Zoning District: �p C H�4�v�c,f> <br /> Fire Department: Post O�ce: School District: <br /> Lot Area: Sq.ft. Acres Width Dep[h <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: <br /> Front (Lake): Right Side: <br /> Rear (Stree[): Left Side: <br /> Ad;acent Structures: `Vetland: <br /> Building Height: Def. Hgt. Peal:Hgt. <br /> Lot Covera�e: <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning F:le: # Resol ion: # Resolution Date: <br /> Shoreland District: <br /> Av'. Setback: Bluff Se[back: L.ot Coverage: <br /> Ezisting Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 2�0-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REVLARKS (in house): D o,� ��0 5�,� g �v��..�.a�,o..� ,r c...�s ��•�.�� � 6� i.-•i <br /> �od/C C v^.�� n� C i rz Go�-�ra( /'f%1�✓lJ /���v rnv� ��✓v /��s /��i���'J <br /> / <br /> 7 <br />