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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> ' 3,�5 FOR OFFICE USE ONLY • <br /> ADDRESS OR LEGAL: •�}SS� N �R-�r pr 2trr. c.tA N t= <br /> PID: <br /> DESCRIPTION OF WORK: STo Ivt�+� �,A r�rL �►,/� <br /> ZO.�tI�Ti G REVIEW BY: DATE APPROVED: �/-Z-�'s� <br /> BUII�D�1G REVIEW BY: �'v (�}, � DATE APPROVED: <br /> FEES TO BE CHARGED: (o��i� Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Yes No SEWER CONNECTION <br /> STATE SURCHARGE Yes No WATERCONNECTTON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZONJI�. 1G CH�CB LIST Zoning District: . <br /> Fire Department: Post Ofhce: School District: � <br /> Lot Area: Sq.ft. Acres � Width Depth <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: � <br /> Front(Latce): Right Side: � � <br /> Reaz(Sueet): Left Side: <br /> Adjacent Structures: Wetland: <br /> Building Height: Def. Hgt. Peak Hgt. <br /> .1� Lot Coverage: ' <br /> �� <br /> �� IL Grading: Staff Approval Date: By: Council Approval Date: <br /> 0r . <br /> -.f �, Septic: Staff Approval Date: By: <br /> Y", <br /> Zoning File: # Resolution: # Resolution Date: <br /> Shoreland District: <br /> Avg. Setback: Bluff Setback: Lot Coverage: <br /> � Ezisting 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 /> REMARKS(in house): _ <br /> 7 <br />