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� <br /> �!.? " CHECK OFF LIST FOR ISSUANCE OF PERMITS �l��� <br /> � <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 3�c�c� 5 t�p 2.cc,��v c� (�2 <br /> PID: <br /> DESCRIPTION OF WORK: �l lo� <br /> ZOtiNi G REVIEW BY: DATE APPROVED: r o -z Y -v� <br /> BUILD�G REV�W BY: — DATE APPROVED: <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes No <br /> PLAN REVIEW Yes No SEWER CONNECITON <br /> STATE SURCHARGE Yes No WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZOVIl�tG CH�CK LIST Zoning District: <br /> Fire Department: Post O�ce: School District: <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes�_ No Date of Survey: Ok tr�p <br /> Proposed Setbacks: <br /> Front (Lake): i C�` Right Side: <br /> Rear (Street): Left Side: <br /> Adjacent Structures: Wetland: <br /> Building Height: Def. Hgt. Peal:Hgt. <br /> Lot Coverage: <br /> /(/•/} ' <br /> Gradine: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning 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 /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS (in house): <br /> 7 <br />