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� <br /> CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: �l 1�� t� �t�1-�W�t��� 2�t�+ � <br /> PID: <br /> DESCRIPTION OF WORK: j� I l . <br /> Z0�1G REVIEW BY: DATE APPROVED: 3_ � - o-z <br /> BUII.DING REVIEW BY: DATE APPROVED; <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> �PERNIIT Yes i/ No <br /> PLAN REVIEW Yes No SEWER CONNECTION <br /> STATE SURCHARGE Yes No WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No STTEINSPECTTON <br /> Number of SAC�Units OTHER (specify) <br /> ZONING CH�CK LIST zoning District: �/'o c r.�-•4-r/(� <br /> Fire Department: Post Office: School District: � <br /> Lot Area: Sq:ft. Acres Width Depth <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: , <br /> Front(Lake): Right Side: � <br /> Reaz(Street): Left Side: I S � <br /> Adjacent Structures: Wetland: <br /> Building Height: Def. Hgt. Peak Hgt. <br /> Lot Coverage: <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File: # Resolution: # Resotution Date: <br /> Shoreland District: <br /> Avg. Setback: Bluff Setback: Lot Coverage: <br /> Ezisting Proposed <br /> Hazdcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS(in house): <br /> �►�K (.wN� ��,t�r��,�.�� - No Lu,� - nro c�rrG�rrecra ►=�:`S <br /> 7 <br />