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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: Sv �y(Z��Woo D �.� <br /> PID: <br /> DESCRIPTION OF WORK: (J Ecxs <br /> ZO�G REVIE�V BY: DAT'E APPROVED: 6- �.�-�'1 <br /> BUILDI�i 1G REVIEW BY: DATE APPROVED; _�-zq •o y <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PER1vIIT Yes �/ No <br /> PLAl�t REVIEW Yes _� No SEWER CONNECTION <br /> STATE SURCHARGE Yes _� No WATER CONNEC'I ION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No STTEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZONING 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: 5-243-7f3 <br /> Proposed Setbacks: A k � <br /> Front(Lake): b S t o� Right Side: y�"a �lLv <br /> Reaz(Street): Iy0 � �� Left Side: � �� L>� <br /> Adjacent Structures: A��+��� �Vetland: N K <br /> Building Hei.�aht: Def. Hgt. � Peak Hgt. <br /> Lo�Coverage: �- <br /> GradinD: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # — Resolution: # Resolution Date: <br /> Shoreland District: n!� <br /> Avg. Setback: Bluff Setback: L.otCoverage: <br /> Existing 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 /> 7 <br />