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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS ORLEGAL: 27�p P���—�s,4iv-r /lu� <br /> PID: <br /> DESCRIPTION OF WORK: cH�w�e �tocF P�TCH r Aao �ivmc, <br /> Z0.�1I�ti G REVIE`V BY: DATE APPROVED: �- �- a y <br /> BUII..DING REV�`V BY: DATE APPROVED; �-7- a Y <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes �/ No <br /> PLAN REV�W Yes � No SEWER CONIVECITON <br /> STATE SURCHARGE Yes �/ No WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTTON <br /> Number of SAC�Units OTHER (specify) <br /> ZO�G CHE.CK LIST Zoning District: G�-��S <br /> Fire Department: Post Office: School District: � <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes_� No Date of Survey: �d�/7- d 3 <br /> Proposed Setbacks: <br /> F�Fe�-(Lake): _ Nd C(���RightSide: N�C <br /> Reer (Street): 2°�' Left Side: N/C <br /> Adjacent Structures: — �Vetland: <br /> Building Hei?ht: Def. Hgt. d�� Peal:Hgt. — <br /> Lot Covera�e: NO C�+�.v�,.� <br /> Grading: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # fas� u 3-29c o Resolu[ion: # 3b 8•� Resolution Date: �y z y- 0 3 <br /> Shoreland District: y,�S <br /> Avg. Setback' o,�� Bluff Setback: ,� /� L.ot Covenge: <br /> Existing Proposed <br /> Hardcover: 0-75' � <br /> 75-250' 27•�5 <br /> 250-500' . <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: � <br /> RENIARKS (in house): <br /> 7 <br />