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� .. CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: ?,y(� �0 2�-� �4 rz,i►� �...�q N c= <br /> PID: <br /> DESCRIPTION OF WORK: p�c,t.��.-� z z x 3�t C��t,a-6�e <br /> ---- --------------------------------- . -�-o <br /> ZO.�IYi G REVIEW BY: DATE APPROVED• Y' � <br /> BUII,D�IG REVIEW BY: DATE APPROVED; y- � -0 3 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes � No <br /> PLAi�1 REVIEW Yes �/ No SEWER CONNECTION <br /> STATE SURCHARGE Yes �/ No WATER CONNECI'ION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <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. n�/�c, Acres Width Depth <br /> Survey Submitted: Yes� No Date of Survey: mr F�t.�: <br /> Proposed Setbacks: <br /> F�ant(Lake): '-t d0� �" Right Side: ?�` <br /> R�ar(Street): i o I,eft Side: (�7 <br /> Adjacent Structures: ��� 1�Vetland: N��i4 <br /> Building Hei;ht: Def. Hgt. �`,y' Peal:Hgt. 2 I ' 3 <br /> L,o[Coverage: /t��/�F <br /> Grading: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # — Resolution: # Resolution Date: <br /> Shoreland District: ��.ps b��.�-� <br /> Avg. Setback: �K p.eR. Bluff Setback: i✓//�- Lot Coverage: N�A <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' �•�C <br /> 250-500' <br /> 500-1000' �`-I•� <br /> Hardcover Variance Required: Yes No_� Date of Council Approval: <br /> RENiARKS (in house): <br /> 7 <br />