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CHECK OFF LIST FOR ISSUANCE OF PERNIjTS <br /> � FOR OFFICE USE ONLY <br /> ADDRESS ORLEGAL: ��'�� '�M�S't�oc�xV R.A�� _ <br /> PID: <br /> DESCRIPTION OF WORK: ��c'wt.o�Et._ <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> Z0�1�'G REVIEW BY: DATE APPROVED: s'-�5� SF� <br /> BUILDL\TG REVIE`V BY: DATE APPROVED: 5'-!5 -S� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes v' No <br /> PLAN REVIEW Yes �' No SEWER CONNECTION <br /> STATE SURCHARGE Yes � No WATERCONNECTTON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZOi\TTi�'G CHECK LIST Zoning Districr. <br /> � lU0 G t-�A N C� �- <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 /> Rear (Street): Left Side: <br /> Adjacent Structures: Wetland: <br /> Buildin; Height: Def. Hgt. Peak Hgt. <br /> Lot CoveraQe: <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File: # Resolution: # Resolution Date: <br /> Shoreland District: <br /> Av;. Setback: Bluff Setback: Lot Coverage: <br /> Existing Proposed <br /> Hardcover: 0-7�' <br /> 75-250' <br /> 2�0-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REI�ARKS (in house): = <br /> 7 <br />