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. <br /> CFIECK OFF LIST FOR ISSUANCE OF PERMITS <br /> ' , FOR OFFICE USE ONLY <br /> ADiDRESS OR LEGAL: Z�5� �N��s�,-r (�-�-�� <br /> �PID: <br /> DESCRIPTION OF WORK: ���-r/� �,��nt� d���'�•� <br /> ZO.vI�ti G REVIEW BY: �1/� DATE APPROVED: <br /> BUII�DING REVIEW BY: DATE APPROVED: S—��--o� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes �/ No <br /> PLAN REVIEW � Yes No � SEWF�CO�tNEC?TON <br /> STATE SURCHARGE Yes c/ No WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZO�TIVG CH�CK LIST Zoning District: Nv c'�f� <br /> Fire Department: Post O�ce: School District: <br /> Lot Area: Sq.ft. Acres Width Dep[h <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: <br /> Front(Lake): Ri Side: <br /> Rear(Street): ft Side: <br /> Adjacent Structures: Wetland: <br /> Building Height: Def. Hgt. Peal:Hgt. <br /> Lot Coverage: <br /> Grading: Staff Approval Date: Council Approval Date: <br /> Septic: Staff Approval Date: y: <br /> Zoning File: # Resolution: # Resolution Date: <br /> Shoreland District: <br /> Avg. Setback: Bluff S tback: Lot Coverage: <br /> Eatistin Proposed <br /> Hazdcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> SOQ-1000' <br /> Hazdcover Variance Required: Yes o Date of Council Approval: <br /> RENIARKS(in house): <br /> 7 <br />