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, CHECK OFF LIST FOR ISSUANCE OF PER�I�IITS <br /> ' FOR OFFICE USE ONLY � <br /> ADDRESS OR LEGAL: ��O I�f o r21�1 v4 r2 vv� �-Ar�►L <br /> PID• <br /> DESCRIPTION OF WORK: d��c J���Pc,acsZ vY-o..�- __ <br /> ZO�'G REVIEW BY: DATE APPROVED: S-'`�- d� <br /> BUII..DING REVIEW BY: DATE APPROVED; s'-`1-ao <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓' No <br /> PLAN REVIEW Yes No SEWER CONNECTION <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 CI�CB LIST Zoning District: o c�-� + �•� <br /> Fire Department: Post Office: School District: � <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: <br /> Front(Lake): Right Side: <br /> Reaz(Street): Left Side: <br /> Adjacent Structures: Wetl d: _ <br /> Building Height: Def. Hgt. Peak gt. <br /> Lot Coverage: <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File: # Resolution: # Resoluaon Date: <br /> Shoreland District: <br /> Avg. Setback: Bluff Setback: Lot Coverage: <br /> Existing Proposed <br /> Hazdcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hazdcover Variance Required: Yes No Date of Council Approval: <br /> REMARI�S(in house): o D��� Gv� /.�G/� Si9-m� �9s v!1� 6.�'1'�. <br /> (:.�w ►�s o�.+ P w,ti►s f L�'v ���e v.-.� I- i -?� - 7"r � <br /> �.�/ hfi4n-Da� <br /> 7 <br />