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. <br /> CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY . <br /> ADDRESS OR LEGAL: Z 6 6 o w�A P t� Rlnb c� Gv4-�� <br /> PID: / <br /> DESCRIPTION OF WORK: /�-�vwdc;Z <br /> ZOi�tING REVIEW BY: DATE APPROVED: �- $�-03 <br /> BUII.DING REV�W BY: DATE APPROVED: � -g-�-3 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> pERMIT Yes �� No <br /> pLAN REVIEW Yes r/ No SEWER CONNEC"TION <br /> STATE SURCHARGE Yes c/ No WATER CONNECTTON <br /> INVESTIGATION FEE Yes No � PARK FEE <br /> SAC Yes No �/ SITEINSPEC"fION <br /> Number of SAC Units OTHER (specify) <br /> ZOr'ING CHECK LIST Zoning Districr. /vo Gffi4,v(,� <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: Wetland <br /> Building Hei�ht: Def. Hgt. Peal:H . <br /> Lot Coverage: <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File: # Resolution: # R solution Date: . . . <br /> Shoreland District: <br /> Avg. Setback: Bluff Setback: Lot Coverage: <br /> EaistinD Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS (in house): <br /> . <br /> 7 . , <br />