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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: �g� p x F-o rZ,p �Zo�� <br /> PID: <br /> DESCRIPTION OF WORK: �C2t�N (�o.�c.6. � 3 st.-yasoN W,r-i-� �v e w I�cd-� <br /> ZO,�i G RE'VIEW BY: � W- --�M-------------DATE APPROVED: $- 2�(�o� <br /> BUII,DII`G REVIEW BY: DATE APPROVED: 8•z5 -o s <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW � Yes �/ No SEWF.R CONNECTION <br /> STATE SURCHARGE Yes ✓ No WA'TERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZOPTIt�tG CHE.CK LIST Zoning District: T �v c.F+�,•�c�.e <br /> cJ <br /> Fire Department: Post O�ce: School District: <br /> Lot Area: Sc.ft. Acres Width Depth <br /> Survey Submitted: Yes No e of Survey: <br /> Proposed Setbacks: <br /> Front(Lake): Right Side: <br /> Reaz (Street): Left Side: <br /> Adjacent Structures: tland: <br /> Building Height: Def. Hgt. Peal:Hgt. <br /> Lot Coveraae: <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 /> Av�. Setback: Bluff Set ck: Lot Covera�e: <br /> Ezisting Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 2�0-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> RENIARKS (in house): <br /> � <br />