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� ' <br /> CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: Z 5 S L���'4'►�4n-tC /J2 <br /> PID: <br /> DESCRIPTION OF WORK: �2�v--e wAti, e4c.^cL'-�iz.e� <br /> ------------------------------------------- ---------------------------------------------------------------------------- <br /> ZONING REVIEW BY: DATE APPROVED: 8 -12- �r L <br /> BUILDING REVIEW BY: �r�r� DATE APPROVED: <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ��''O� <br /> PLAN REVIEW Yes No SEWER CONNECTION <br /> STATE SUR:I-�ARG� Yes No WATER CONNECTION <br /> INVESTIGAZ'ION-FEE Yes No PARK FEE <br /> SAC Y�s No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING CHECK LIST zoning District: <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: I O � <br /> Rear (Street): Left Side: <br /> Adjacent Structures: Wetland: <br /> � Building Height: Def. Hgt. Peak Hgt. <br />�, <br /> Lot Coverage: <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File: # Resolution: # Resolution Date: <br /> Shoreland Dist:ict: <br /> Avg. Setback: Bluff Setback: I.ot Coverage: <br /> Existing 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 /> � 26 <br />