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� � � <br /> CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: l 2$o c.,y ww.rv q�•.p <br /> PID: ' <br /> DESCRIPTION OF WORK: /4/�/�r Tt o�15 — c.��n�I.•v o/L�w.vAc. �or�t.res <br /> --------------------------------------- _--- _____------------------------------------------------------------------- <br /> ZONING REVIEW BY.• DATE APPROVED: �- �.�-�r <br /> BUILDING REVIEW BY: DATE APPROVED: � -3 0 -v� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes � No <br /> PLANREVIEW Yes r/ No SEWER CONNECTION <br /> STATE SURCHARGE Yes �/ No WATER COIVNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No ' SITE INSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ----------------------------------------------------------------------------------------------------------------------- <br /> ZONING CHECK LIST' Zoning District: /Vc) G H A p�Q <br /> Fire Department: Post Office: School District: <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): Left Side: <br /> Adjacent Structures: Wetla • <br /> Building Height: Def. Hgt. Peak H t. <br /> Lot Coverage: <br /> Grading: Sta,ff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File: # Resolution: # esolution Date: <br /> Shoreland District: <br /> Avg.Setback: Bluff Setback: Lot Coverage: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> asasoo� <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS(in house): <br /> 32 <br />