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CHECK OFF LIST FOR ISS UANCE OF PERMITS <br /> FOR OFFICE USE ONL Y <br /> ADDRESS OR LEGAL: r�'��,�/Cc?,ti i��v ��'f/-�C',Q � <br /> PID: <br /> DESCRIPTION OF WORK: G� f:S G'v^�... wi � L! S�l(¢�J <br /> ---------------------------------------------------�/----------------------------------------------------- � 7 � <br /> ZONING REVIEW BY: t" DATEAPPROTtED: <br /> BUILDINGREVIEWBY.• DATEAPPROVED: b -cl- D� <br /> FEES TO BE CHARGED: Misc. Fees Cczlczclatec�By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Yes�- No SEWER CONNECTION <br /> STATE SURCHARGE Yes—� No WATER CONNECTION <br /> INVESTIGATION FEE Yes No �"' PARK FEE <br /> SAC Yes No� SITE INSPECTION <br /> Number of SAC U�its � OTHER (specify) <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING CHECK LIST za�if�g District: L�' �� <br /> Fire Depai�tment: Post Office: School District: <br /> Lot.4r�ea: Sg.ft. Ac�•es Width Depth <br /> Survey Sarbmitted: Yes No_ Date of Sttrvey: <br /> Pr•oposed Setbacks: <br /> Front(Lake): Right Side: <br /> Rear(Stf•eet): Left Side: <br /> Adjacent Struct��res: Wetland: <br /> B�uilding Height: Def Hgt. Peak Hgt. <br /> I,ot Cover•age: <br /> Grading: Sta�f'App�-ova!Date: By: Council Approval Date: _ <br /> Septic: Staffrlpproval Dnte: By:�� <br /> 7_vi�ing I'ile: # Resola�tiorr: # Resolzrlia�Date: <br /> Shoreland Distr•ict: r�lCG�D Pei�mit: <br /> �vg. Setback: l3lLrffSetback: LotCoverage: <br /> Existing Proposed <br /> Kardcover: 0-75' <br /> 7�-?SO' <br /> 2�0-�00' <br /> �00-1000' <br /> Hardcover �ariance Reg��ired: }'es �Vo Date of Coa�ncil�lpproval.� <br /> REMARKS(in hoirse): !/Y � U[f2G � <br /> l S � X[ � � ��� � (� � <br /> rd(S�e�( o �'' l �? ' �,vcuCd !� <�c--1 G'��'I � �C.vi �C� /�� <br /> >; <br />