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° • CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: �zs w►�G. f(,�,,. �� _ <br /> PID: <br /> DESCRIPTION OF WORK: nrE�,y �� <br /> ZO�tG REY�W BY: DATE APPROVED: �i-i 6-03 <br /> BUII.DI�i TG REY�`�BY: DATE APPROVID; q�r v=�3 � <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: , <br /> PER11iIIT Yes � No <br /> PLA��t REVIEW Yes � No SE'GYER CONNEC'TIOI�i <br /> STATE SURCHARGE Yes ✓ No WATERCONNECITON <br /> INVESTIGATION FEE � Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZONL�TG CH�CK LIST Zoning District: . <br /> Fire Department: � Post Office: School District: • �. � <br /> Lot Area: Sq�.ft. Acres � Width Depth <br /> Survey Submitted: Yes_� No Date of Survey: (�•2-b 3 <br /> Proposed Setbacks: � � � � <br /> Front(Lake): i 10 Right Side: �.31 � <br /> Reaz(Street): (7 3 Left Side: N�Ja <br /> Adjacent Structures: N//a Netland: �/�� . <br /> Building Hei�ht: Def. Hgt. Z�l•S Peal:Hgt. �/� <br /> Lot Coverage: /�!� <br /> Gradina: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: ��- [� 'C�� By: o`=�V• <br /> Zoning File: # — Resolution: # Resolution Date: � <br /> Shoreland District: /V'� <br /> Avg. Setback: Bluff Setback: I.otCoverage: <br /> . Existino Proposed <br /> Hardcover: 0-75' . <br /> 75-250' <br /> Z50-500' <br /> 500-1000' <br /> Hazdcover Variance Required: Yes No Date of Council Approval: <br /> RE1��ARKS (in house): .�� (—��� �T P�.( C�4�– 1��U vT. _ <br /> W A-r�(LSt�� �U�S-rrt.cc�' Jl�'�• '� - `�. <br /> 7 . , . " � '!.�'�� <br /> ��� _ (c' <br />