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. . � <br /> CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 56 v ic.n I�s K F,a�— <br /> PID: <br /> DESCRIPTION OF WORK: o o� <br /> ZO�IG REVIE�V BY: DATE APPROYED: �•$-v./ <br /> BUII..DING REVIE`Y BY: DATE A.PPROVED; -�6 •0�1 <br /> FEES TO BE CFIARGED: Misc. Fees Calculated By: <br /> PER�I�IIT Yes c/ No <br /> PLA��I REVIEW Yes v' No SEWE.R CONNECTION <br /> STATE SURCHARGE Yes � No WATERCONNECI'ION <br /> INVESTIGATION FEE � Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> Z011'ING CHE.CK LIST Zoaing District: . <br /> Fire Department: Post Office: School Districr. � <br /> Lot Area: Sq.ft. Acres � Width Depth <br /> Survey Submitted: Yes� No Date of Survey: o"' �<<CF' <br /> Proposed Setbacks: <br /> Front(Lake): 2 35 � ± Right Side: $d � <br /> Reaz (Street): '3�G � '�' Left Side: �N�7� � <br /> Adjacent Structures: 70` Wetland: <br /> Building Height: Def. Hgt. — Peal:Hgt. — <br /> Loc Coverage: N �� <br /> Grading: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: �' By: <br /> Zoning File: # � Resolution: # Resolutioa Date: � <br /> Shoreland District: i/� <br /> Avg. Setback: Bluff Setback: Lot Coverage: <br /> Existine Proposed <br /> Hazdcover: 0-75' <br /> 75-250' � <br /> 250-500' <br /> 500-1000' <br /> Hazdcover Variance Required: Yes No Date of Council Approval: <br /> REMAR��S(in house): <br /> 7 <br />