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-� � CHECK OFF LIST FOR ISSUANCE OF PERI�IITS <br /> FOR OFFICE USE ONI,Y • . <br /> ADDRESS OR LEGAL: �c�u V u u. c.�w e. R.�vJ�c. <br /> PID: <br /> DESCRIPTION OF WORK: F�tiV 1Sti i314S�Mlr►'v� <br /> ZO�"G REYIEW BY: N (� DATE APPROZ�D: � <br /> �. BL'ILDLIIG REVIE�BY: � � DATE APPROYED; �z- 3-c�c� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes �/ No <br /> pLAN REV�W Yes ✓' No SEWER CO��CTION <br /> STATE SURCHARGE Yes _sG No `VATF�tCONNECTTON <br /> IIWESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No STT'E 1NSPECTION <br /> Number of SAC•Units OTHER(specify) <br /> ___________--------- <br /> ZO`Zti G CS�CB LIST Zoni.ng Districr. w o c rt�•�2 <br /> Fire Department: Post Office: School DsSict: • � <br /> Lot Area: Sq.ft. Acres " idth Depth <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: <br /> Front(Lake): Right Side: � . <br /> Rear(Street): I.eft Side: <br /> Adjacent Structures: Wetl d: <br /> Building Height: Def. H;t. Peak gt. <br /> Lot Coverage: ' <br /> Grading: Staff Approval Date: B Council Approval Date: <br /> Septic: Staff Approval Date: B <br /> Zonin�File: # � Resolution: # Resolurion Date: <br /> Shoreland Disuict: <br /> Av�. Setback: Bluff Setback LotCo�zra�e: <br /> � Existmg Progoscd <br /> Hazdcover: 0-75' <br /> . 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hazdcover Variance Required: Yes No Date of Council Approval: <br /> REI�iA.RKS('in house): <br /> 7 <br />