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• CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> , FOR OFFICE USE ONLY <br /> A.DDRESS OR LEGAL: 34 0 No 2Z"1-1 �2v►� �wN� <br /> PID: <br /> DESCRIPTION OF WORK: �S1�=t� <br /> ZO�NG REVIE�V BY: � DATE APPROYED: g�-�y <br /> BUII.DI�IG REYIE'�V BY: DATE APPROVED; S�•3:o,, <br /> FEES TO BE CHA.RGED: Misc. Fees Calculated By: <br /> PER1ti1IT Yes � No <br /> PLAl�t REVIEW Yes No SEWER CO�]NECITON <br /> STATE SURCHARGE Yes � No WATERCONNECTION <br /> INVESTIGATION FEE � Yes No PARK FEE <br /> SAC Yes No SI'TEINSPECTION <br /> Number of SAC-Units OTHER (specify) <br /> ZONING CH�CK LIST Zoaing District: <br /> Fire Department: Post O�ce: School District: � <br /> L.ot Area: Sq.fr. Acres ' Width Depth <br /> Survey Submitted: Yes_ c No Date of Survey: oh, �h��e <br /> Proposed Setbacks: � <br /> F�oat(Lake): (p 0l � = Right Side: `tU� t <br /> B.ee.r(Street): yU ` f Left Side: ZoD� � <br /> Adjacent Structures: I 0 � 'z `Vetland: �•(L <br /> Building Height: Def. Hgt. � ��,L. Peak Hgt. �- <br /> Lot Coverage: N/�I <br /> Gradino: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # -- Resolution: !# Resolution Date: � <br /> Shoreland District: � �� <br /> Avg. Setbac ��� Bluff Setback: � I.ot Coverage: � <br /> Eusting Proposed <br /> Hazdcover: 0-75' <br /> 75-250' � � <br /> 250-500' I D` �' <br /> 500-1000' <br /> i <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> RE1I�IARI�S(iIl hOitSe): <br /> 7 <br />