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� <br /> • CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 3���°j C��v�•vG Stt�N �A-c.-�P <br /> PID: <br /> DESCRIPTION OF WORK: �toN �� g c�4 N� C�C�cic �,�4-f<S <br /> ZONING REVIEW BY: nJ �.�9 DATE APPROVED: <br /> BUII.DING REVIEW BY: DATE APPROVED: 4 •�• �o <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes _� No <br /> PLAN REVIEW Yes No �/' SEWER COrINECTION <br /> STATE SURCHARGE Yes � No WATERCONNECT'ION <br /> INVESTIGATION FEE Yes No , PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECK LIST Zoning District: /Uc� G�{?'!r/G� <br /> v <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: <br /> Rear(Street): Left Side: <br /> Adjacent Structures: etland: <br /> Building Height: Def. Hgt. ak Hgt. <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 District: <br /> Avg. Setback: Bluff Set ack: L.ot Coverage: <br /> Existing 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 /> REMARKS(in house): <br /> 7 <br />