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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: /3 Z.� sf,►oit.c�i.�E. D�t. � <br /> PID: �� <br /> D�SCRIPTION OF WORK: e,vey�a�+c,�: ' n�•o,v„ ,�.,,,,�-,.•T5 <br /> ---------------------- ------------------ <br /> Z0.�1I�ti G REVIEW BY: �� C,Q.t,,,�,.._ DATE APPROVED• <br /> BUII,DI1i 1G REV�W BY: DATE APPROVED; <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERlI�lIT Yes ✓� No <br /> PLAl�T REVIEW Yes �- No SEWER CONNEC"TION <br /> STATE SURCHARGE Yes _f� No WATERCONNECTION <br /> INVESTIGATION FEE � Yes No PARK FEE <br /> SAC Yes No SITEINSPECTTON <br /> Number of SAC�Units OTHER (specify) <br /> ZONING CHE.CK LIST Zoning District: <br /> Fire Department: Post Office: School District: • <br /> Lot Area: Sq.ft. Acres � Width Depth <br /> Survey Submitted: Yes�[_ No Date of Survey: �n• �_�� <br /> Proposed Setbacks: � <br /> F',reat(Lake): 30 0' } Right Side: � Z <br /> , <br /> �eer(Street): $ Lefr Side: 2 3 a <br /> Adjacent Structures: '?�u o ` �- Wetland: c�•k <br /> Building HeiDht: Def. Hgt. 5` Peal:Hgt. <br /> Lot Coverage: ,� /oa <br /> Grading: Staff Approval Date: —' By: Council Approval Date: <br /> Sepdc: Staff Approval Date: — By: <br /> Zoning File: # — Resolution: # Resolution Date: <br /> Shoreland District: �,�tS <br /> Avg. Setback: Bluff Setback: I.ot Coverage: <br /> Existing Proposed <br /> Hardcover: 0-75' �•�� <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hudcover Variance Required: Yes No � Date of Council Approval: <br /> REMA.RKS (in house): <br /> 7 <br />