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� � CHECK OFF LIST FOR ISSUANCE OF PERII�IITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: S�0 ���c..cs �+ ,=►�R w. <br /> PID: <br /> DESCRIPTION OF WORK: �r c w (2.E5 <br /> ZO�G REVIEW BY: �P DATE APPROVED: /Z 2- 03 <br /> BUILDI�i 1G REVIEW BY: DATE APPROVED; �Z-1= n3 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes f No <br /> PL?,l�T REVIEW Yes _� No SEWF�t CONNECTION <br /> STATE SURCHARGE Yes JNo WATERCONNECTTON <br /> INVESTIGATION FEE � Yes No_,C PARK FEE <br /> SAC Yes No � SITEINSPECTION <br /> Number of SAC-Units OTHER (specify) <br /> ZONING CH�CK LIST Zoning District: .. <br /> Fire Department: Post Office: School District: � <br /> Lot Area: Sq.ft. Acres 5_� � aidth Depth <br /> Survey Submitted: Yes o� No Date of Survey: i�-t�t-03 <br /> Proposed Setbacks: � <br /> Front(Lake): 1 SO' � Right Side: tr !0 3� �= <br /> Rear(Street): �{L`(` .� Left Side: G•� �� � <br /> Adjacent Structures: /Il//a- Wetland: �po r <br /> Building Height: Def. Hgt. 2�t��S Peal:H�. 3�•g <br /> Lot Coveraae: /�/ (A- <br /> Gradina: Staff Approval Date: I Z- ►-u� By: U � Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File: # — Resolution: # Resolution Date: — <br /> Shoreland District: /� � <br /> Avg. Setback: Bluff Setback: Lot Coverage: <br /> Existina Proposed <br /> Hardcover: 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 /> 7 <br />