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� �� CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> �� FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: I l g0 Coit�4 u�v p A ��.Q <br /> PID: <br /> DESCRIPTION OF WORK: n!LsLc/ /Lot�r=' ���2v��-✓�'` <br /> ZO�TG REV�W BY: DATE APPROVED: /d y�-a/ <br /> BUII.DING REVIEW BY: DATE APPROVED; i v-��-u� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes I/' No <br /> PLAN REVIEW Yes No� SEWER CONNEC'ITON <br /> STATE SURCHARGE Yes � No WATER CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No STTEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZONING CH�CK LIST Zoning District: iU v �ciQ <br /> O <br /> Fire Department: Post Office: School District: � <br /> Lot Area: Sq.R. Acres Width Depth <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: <br /> Front(Lake): Right ide: <br /> Reu(Street): Left Si e: <br /> Adjacent Structures: Wetland: <br /> Building Height: Def. Hgt. Peal: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 Disuict: <br /> Avg. Setback: Bluff Set ck: Lot Coverage: <br /> Eusting Proposed <br /> Hazdcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes N Dace of Council Approval: <br /> REMARKS (in house): <br /> 7 <br />