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� ' CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY • <br /> ADDRESS OR LEGAL: S S� O X�0 R J� ��A�✓J <br /> PID• <br /> DESCRIPTION OF WORK: �(Z �,�w�,,, ,A�cb (��sc.��n�, <br /> ZO�TING RE`VIEW BY: DATE APPROVED: -�'!- L�S� <br /> BUII.DPTG REVIEW BY: --- � DATE APPROVED: <br /> FEES TO BE CHARGED: ����} Misc. Fees Calculated By: <br /> PERMIT Yes � No <br /> PLAN REVIEW Yes No SEWER COriNECTION <br /> STATE SURCHARGE Yes No WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC�Units OTHER(specify) <br /> ZOYING CH�CS LIST Zoning District: � c r��.( <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 /> Buildin;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:# Resoludon 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 /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS(in house): <br /> 7 <br /> � <br />