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, �CHECK OFF i.IST FOR ISSUANCE OF �E�tMITS <br /> . FOR OFFICE USE ONL�'� . . <br /> ADDRESS OR LEGAL: /l�1� �'� v�� � �'� <br /> PIl7: <br /> DESCRIPrii,ION OF WORK: GV��I ��� <br /> -------------------------�------------- <br /> ------__------------------ � � y l�� <br /> ZO�G REVTE'�V BX: ---- — DE1.TE APPROYED: <br /> BUII,DING REVIEtiY BY_ �_ -------------DATE APPROVED-----�-_l o o co-- <br /> FEES TO BE CHA,RGEA: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN R.EVIEtiV � Yes ,/ No SEWER COYNECTION <br /> STATE SURCHARGE Yes � No tiVATERCONNECTION <br /> IIVVESTIGATION FEE Yes No ✓ PARK FEE <br /> SAC Yes No '✓ STTEINSPECTION <br /> Number of SAC�Units OTHER (specify) . <br /> ZONIt�TG CT-iE.CK LIST zoning Discrict------V���------r------ . <br /> � Post Office: School District: • � <br /> Fire Department: - <br /> " , , " Acres b.7 I ' Width '^ � Q�C.�- DePch `^ �IU� <br /> L,ot Area: Sq.ft.�,.,71 j,_._ � . 0.@✓�-'✓ <br /> Survey Submitted: Yes�_ No �` Date of Survey: o a ��c-� `�-2S�S� <br /> Proposed Setbacks: • : <br /> Froat(Lake): Right Side: . <br /> � , , � � , . <br /> Rear(Sueet): � e t ide: � <br /> Ad;acent Struetures: � (v Wetland: N �I� <br /> Buildin� Hei;hc: Def. Hgt. /� � Peal:Hgt. I 9� <br /> Lot Covera?e: <br /> ��� <br /> Grading: Staff Approval Date: `� `l�—�� BY: �_ �o�cil Approval Date: �- ' <br /> Septic: Staff Approval Date: V V �Y� �- �v� <br /> Zoaing File: � N 1�l _ Resolutioo: # _ Resolution Date: <br /> Shoreland Distric�: �I � <br /> . ,�, <br /> Av�. Setback: ��-tv Bluff Setback: tl l� � L.o[Covem�e: <br /> Existing Proposed <br /> Hardcover: G-75' <br /> 75-250' �,�� <br /> 2�0-500' �• � <br /> 500-1000' <br /> H��dcover Variznce Required: Yes No � Date oF Cou�cil Approvz: <br /> FE��L�S (inhouse): <br />