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� • . CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY � <br /> ADDRESS OR LEGAL: +-t Z b'3 I�oI�.T1� S M-o2� lJst � <br /> PID: <br /> DESCRIPTION OF WOR$: rv l.�A- <br /> ZONING REV�W BY: ,/G DATE APPROVED: S'•'� 'c�b <br /> BUII..DING REVIEW BY� DATE APPROVID; S• ''�-mo <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes �► No <br /> PLAN REVIEW Yes ✓ No SERTER COrfNECTiON <br /> STATE SURCHARGE Yes �- No WATERCONNECTION <br /> INVESTIGATION FEE Yes No. PARK FEE <br /> SAC Yes No T STTEINSPECTTON <br /> Number of SAC�Units �THER (specify) <br /> ZONING CH�Cg LIST Zoning District: ivv ���� <br /> Fire Department: Post Office: School District: � <br /> Lat Area: Sq.ft. Acres � idth Depth <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: � <br /> Front(Lake): � Right Side: ° <br /> Rear(Street): Left Side: <br /> Adjacent Structures: Wefl 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: # Resolution Date: <br /> Shoreland District: <br /> Avg. Setback: Bluff Setback: �����= <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REMA.RKS(in house): <br /> 7 <br />