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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESSOR LEGAL: _36-10 - o e o 20 An <br /> PID: <br /> DESCRIPTION OF WORK: o <br /> ZONING REVIEW BY: DATE APPROVED: <br /> BUILDING REVIEW BY: DATE APPROVED; <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Yes G,--' No SEWER CONNECTION <br /> STATE SURCHARGE Yes No WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No STTEINSPECTION <br /> Number of SAC-Units OTHER (specify) <br /> ZONING CHECK LIST Zoning District: <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. W-50 Acres • t g� Width SO Depth 1 VS <br /> Survey Submitted: Yes x No Date of Survey: 4-15- 'd 3 <br /> Proposed Setbacks: <br /> Front(Lake): Ag Cl Right Side: i2 <br /> Rear(Street): SS Left Side: Z5 <br /> Adjacent Structures: r47-rA c td. d Wetland: /J(A <br /> Building Height: Def. Hgt. 0.1< Peak Hgt. <br /> Lot Coverage: 1 Z•�1 <br /> Grading: Staff Approval Date: N I A By: Council Approval Date: <br /> Septic: Staff Approval Date: ti VA By: <br /> Zoning File: # — Resolution: # Resolution Date: <br /> Shoreland District: /,J V <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 />