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• ' CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 2��5 k�1 l�,, (R,4,Q1�v r4 ti <br /> PID: <br /> DESCRIPTION OF WORK: -r�ivn��sv�- I=;,v�sN <br /> ZO��TING REVIEW BY: DATE APPROVED: /v-27-�3 <br /> BUILDING REVIEW BY: DATE APPROVED: o-Z�-� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes c� No <br /> pL?,N REVIEW Yes v No SEWER CONNECTION <br /> STATE SURCHARGE Yes !/ No WATER CONNECTTON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No STTEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZOr'�1G CHECK LIST Zoning Disuict: /licJ G/fi9/Vl Q � <br /> Fire Department: Post Office: School Disuict:. <br /> Lot Area: Sq.ft. Acres idth Depth <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: <br /> Front(Lake): Right Side: <br /> Reaz(Street): Left Side: <br /> Adjacent Structures: We�tland: <br /> Building Heigbt: Def. Hgt. Pe�Hgt. <br /> � <br /> Lot Covera�e: ' <br /> Grading: Staff Approval Date: iBy: Council Approval Date: <br /> Septic: Staff Approval Date: �By: <br /> Zoning File: # Resolution: #i_ Resolution Date: . . <br /> Shoreland District: <br /> Avg. Setback: Bluff Setba�k: Lot Coverage: <br /> g�t�g �, Proposed <br /> Hardcover: 0-75' I <br /> 75-250' -�� <br /> 250-500' � " <br /> 500-1000' I <br /> ; <br /> Hazdcover Variance Required: Yes No Date of Council Approval: <br /> � <br /> REMARKS(in house): � <br /> 7 <br />