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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> _ FOR OFFICE USE ONLY <br /> ,ADDRESS OR LEGAL: � �S �i42� w�c��� <br /> PID• <br /> DESCRIPTION OF WORK: ��� k� <br /> ZO�G REVIEW BY: DATE APPROVED: 2• L b -v Z <br /> BUII..DING REVIEW BY: DATE APPR4VED; 2 -� -vZ <br /> ` f <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PEKMIT Yes �� No <br /> PLAN REVIEW Yes _� No SEWER COrfNE�'TION <br /> STATE SURCHARGE Yes _� No WATER CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZONING CH�CB LIST zoning Districc: . <br /> Fire Department: Post Office: School District: � <br /> Lot Area: Sq�.ft. Acres Width Depth <br /> Survey Submitted: Yes o� No Date of Survey: Os�r �=11X. <br /> Proposed Setbacks: , <br /> �at(Lake): Z>' # Right Side: `f� �' <br /> Rcar(Street): "?O'} Left Side: Z,$"0 � '�'' <br /> Adjacent Structures: /-��7�g G,�� Wetland: /v/� <br /> Building Height: Def. Hgt. ---� Peal:Hgt. <br /> Lot Coverage: — <br /> Grading: Staff Approval Date: —' By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # 2„7ob Resolution: # Resolution Date: 2 •L S--�'Z2 <br /> Shoreland Disuict: <br /> Avg. Setback: Bluff Setback: I.ot Coverage: <br /> Existing Proposed <br /> Hardcover: 0-75' �q•� <br /> 75-250' '?.o•3�6 <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS(in house): <br /> 7 <br />