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� CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: I 1 t� � C Ltn�woo� A u-2 � <br /> PID: <br /> DESCRIPTION OF WORK: Nln�� �02tu2 w u�u �n.e� <br /> . __ u J <br /> ZO�tni 1G REVIEW BY: DATE APPROVED: t3 Y9-a3 <br /> BUII..DI�i 1G REVIEW B : /�1�9 , DATE APPROVED: " � � <br /> FEES TO BE CAARGED: r 6'"1Vlisc�ees NCalculate�By� �� <br /> PERII�IIT Yes � No <br /> PLAN REVIEW Yes _r� No SEWER CONNECITON <br /> STATE SURCHARGE Yes No WATERCONNECTION <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: CeS� d� ��C . <br /> Fire Department: � Post Office: School District: • �. <br /> Lot Area: Sq�.ft. Acres � Width Depth <br /> Survey Submitted: Yes No Date of urvey: <br /> Proposed Setbacks: ' � <br /> Front(Lake): Right Side: _ <br /> Rear(Street): Lefr Side: � <br /> Adjacent Structures: Wetland: . <br /> Building Hei�ht: Def. Hgt. Peal:Hgt. <br /> Lot Coverage: <br /> Gradine: Staff Approval Date: By: C uncil Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File: # Resolution: # Resolution ate: � <br /> Shoreland District: <br /> Avg. Setback: Bluff Setback: Lot Coverage: <br /> Existino Proposed <br /> Hazdcover: 0-75' . <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hudcover Variance Required: Yes No Date of Council Approval: <br /> RE1�ZA,RKS(in house): �� <br /> � - . . . <br />