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CHECK OFF LIST FOR ISSUANCE OF PERI�II'IS <br /> FOR OFFICE USE ONLY • . <br /> ADDRESS OR LEGAL: 43Z 5 1-t�n�� ��2 v� cZo✓�� , <br /> PID: <br /> DESCRIPTIO�T OF WORK: �h►sc:..n��.-� �i�v�s�� --- <br /> ZO.�i�G REY�W BY: DATE APPROVED: .✓�� <br /> �. BL7LD�1G REVIE`V BY: _� � � DATE APPROYF.•D: 2�• 3�-v o� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes ✓' No <br /> pLAN FLEVIEW Yes �- No SEGYER CO�'F,CTION <br /> STATE SURCHARGE Yes �-- No �VATERCONNECTION <br /> INVESTIGATION FEE Yes No P��E <br /> SAC Yes No STTEPii SPECTION <br /> Number of SAC-Units OTHER(specify) <br /> ------------------- <br /> ZO�Z�'G CHECS LIST Zoning District: /�o �-h P . <br /> Fire Department: Post Office: School Dsrrict: - � <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 /> Rear(Street): LeR Side: <br /> Adjacent Structures: W�tl <br /> Building Heiaht: Def. Hgt. Peak °t• <br /> Lot Covera;e: ' <br /> Gradin;: Staff Approval Date: By: Council?,ppro�-2t Date: <br /> Septic: Staff Agproval Date: By: <br /> Zoning File: # Resolution: # Resoludoa Date: <br /> Shoreland District: <br /> Av�. Setback: Bluff Setback: I-°�C°�tra�e= <br /> . Ezistino PrOposcd <br /> Hazdcov�r: 0-?5' . <br /> . 75-250' --- <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of CouncL Approval: <br /> REI+IARKS ('in house): <br /> 7 <br />