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� CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: !Z o S UU 0 R�t-1 ✓-�Q� <br /> PID: <br /> DESCRIPTIONOF WORK: Q y�,,� �Z,�;�,n o,p�.� <br /> ZONING REVIEW BY.• N I A �MY� W DATEAPPROilED:~ ��� <br /> BUILDING REVIEW BY.• � _ . �,_. DATEAPPROVED: I z•S- 07 <br /> ------------------------------ <br /> FEES TO BE CHARGED: Misc. Fees Calculated By.• <br /> PERMIT Yes � No <br /> PLAN REVIEW Yes ,/ No SEWER CONNECTION <br /> STATE SURCHARGE Yes ✓� 1ye WATER CONNECTION <br /> INVESTIGATION FEE Yes ✓41�`�Vo PARK FEE <br /> SAC Yes No ✓ SITEINSPECTION <br /> Number of SAC Units OTHER (specify)_ <br /> ----------------------------------- <br /> ZONING CHECK LIST Zoning District: N o � <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sg.ft. Acres idth Depth <br /> Survey Submitted: Yes No te of Survey: <br /> Proposed Setbacks: <br /> Fron�(Lake): Right Side: <br /> Rear(Street): Left Side: <br /> Adjacent Structures: Wetla d: <br /> Building Height.• Def. Hgt. Peak t. <br /> Lot Coverage: <br /> Grading: StaffApproval Date: By: Council Approval Date: <br /> Septic: StaffApproval Date: By; � <br /> Zoning File: # Resolution: # �Resolution Date: <br /> Shoreland District: �I�ICWD Permit: <br /> Avg. Setback: Bluff Setback: i Lot Coverage <br /> Existing Proposed <br /> Hardcover: 0-75' ''� <br /> 75-250' ' <br /> 250-�00' <br /> 500-1000' <br /> Hardcover 1 ariance Required: Yes No � Date of Council Approval: <br /> REMARKS(in house): 't,l1v C Sn4�'C-1Z-� • ` v '�.� T' <br /> 33 <br />