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� . � <br /> CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> A.DDRESS OR LEGAL: y�Z 5� H/6ff(�o/J /lol4D <br /> PID: <br /> DESCRIPTION OF WORK: �c-c-ci< <br /> - ---- — -'-n-_____ -----------------------------------------:-------------------- <br /> ZO�TIG REVIEW BY: 1�.� DATE APPROYED. -� 2.�, -o Y <br /> BUII�DI�iG REVIE'�V BY: DAT'E APPROVED; �.�,-�y <br /> FEES TO BE CHA.RGED: Misc. Fees Calculated By: <br /> PERII�IIT Yes ,/' No <br /> PL?.��t REVIEW Yes .� No SEWER CO�tNECTION <br /> STATE SURCHARGE Yes c/ No WATERCONNECTION <br /> INVESTIGATION FEE � Yes No PARK FEE <br /> SAC Yes No STTEINSPECTION <br /> Number of SAC-Units OTHER (specify) <br /> ZOYING CHE.CK LIST zoning District: . <br /> Fire Department: Post OfFice: School District: � <br /> L.ot Area: Sq.ft. Acres � Width DePth <br /> Survey Submitted: Yes c No Date of Survey: enr r^�� <br /> Proposed Setbacks: <br /> Front(Lake): q b� r Right Side: ��� '� <br /> � <br /> Reaz(Street): g7 � Left Side: 3�� <br /> Adjacent Structures: RT'r►"�F*� `Vetland: ^//� <br /> Building Hei�b.t: Def. Hgc. �- Pea�:Hgt. — <br /> Lot Coveraoe: — <br /> Gradina: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File: #� Resolution: f# SO! Resolutiva Date: $•l�- o� � <br /> Shoreland District: <br /> Avg. Setback vr�Muv �u Bluff Setback: ,�/l�►- L.otCovenge: - <br /> Existine Proposed <br /> Hazdcover: 0-75' <br /> 75-250' 28.L � <br /> 250-500' <br /> 500-1000' <br /> Hazdcovec Variance Required: Yes o� No Date of Council Approval: g�lI-03 <br /> REI�ZARKS (in house): <br /> 7 <br />