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r . <br /> CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY . <br /> ADDRESS OR LEGAL: (�1 q (M��r�t e-t-w� ��r bN-c�4r'v� [h�+�= <br /> PID: <br /> DESCRIPTION OF WORK: I�1�1�}s�t�t �C;--r��aow.. �?.�=�.9d�z <br /> ZO�TING REVIEW BY: N (� DATE APPROVED: <br /> BUILDING REV�+W BY: DATE APPROVED: 8 -r 2•o�_ <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> pLAN REVIEW Yes � No SEWER CONNEG"ITON <br /> STATE SURCHARGE Yes ✓ No WATER CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPEC'TION. <br /> Number of SAC Units OTHER (specify) <br /> ZOti'ING CHECK LIST Zoning District: iva c,�>v� <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres Widch Depth <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: <br /> Front(Lake): Right S e: <br /> Reaz(Street): I.eft S de: � <br /> Adjacent Structures: Wetland: <br /> Building Height: Def. Hgt. Peak 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 District: <br /> Av�. Setback: Blu Setback: Lot Coverage: <br /> Exis a Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Vaziance Required: Yes No Date of Council Approval: <br /> RE`ZARKS(in house): �' <br /> 7 . , <br />