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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: S�3 P/+2k �.A�►� <br /> PID: <br /> DESCRIPTION OF WORK: (1,ETp�,vl„id �,,,,q�,�., <br /> ZO�PTG REV�W BY: DATE APPROVED: //-2 z aZ <br /> BUII.DING REVIEW BY: DATE APPROVED; /i-u•o Z � <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT-(C3����n�G� Yes �/ No <br /> PLAN REVIEW Yes No �/ SEWER COrfNECTION <br /> STATE SURCHARGE Yes � No WATERCONNECTiON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No STTEINSPECT'ION <br /> Number of SAC�Units OTHER (specify) <br /> ZONING CH�CK LIST Zoning District: . <br /> Fire Department: Post Office: School District: � <br /> Lot Area: Sq:ft. Acres Width Depth <br /> ��' <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: �t �S �„�p({ <br /> Front(Lake): Right Side: Wa,u, �4� <br /> �(�., �� Gc�.. �N <br /> Reaz(Street): Left Side: � � <br /> �,qt� Sc22 Q(� D�7 <br /> Adjacent Structures: Wetland: <br /> Building Height: Def. Hgt. Peak Hgt. <br /> Lot Coverage: <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoaing File: # Resolution: # Resolution Date: � <br /> Shoreland District: ��, <br /> Avg. Setback: Bluff Setback: Lot Coverage: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hazdcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS(in house): <br /> 7 <br />