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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: Zo S T b N" Av c <br /> PID: <br /> DESCRIP'T'ION OF WORK: C KT rz.+iJ cam. ✓4-DM J M P,v t S <br /> ZONLNG REVIEW BY: DATE APPROVED: 6-9- o S <br /> BUILDING REVIEW BY. DATE APPROVED: G-5-o 5- <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes _� No <br /> PLAN REVIEW Yes No SEWER CONNECTION <br /> STATE SURCHARGE Yes ✓ No WATER CONNECTION <br /> INVESTIGATION FEE Yes No �� PARK FEE <br /> SAC Yes No ,/ SITEINSPECTION <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. Acres Width Depth <br /> Survey Submitted: Yes No Date of Survey: S • 21-03 <br /> Proposed Setbacks: <br /> Front(Lake): Right Side: <br /> Rear (Street): Left Side: �,(� S � ,. (,�T G,,.•� <br /> Adiacent Structures: Wetland: <br /> Building Height: Def. Hgt. Peak Hgt. <br /> Lot Coverage: /V/A <br /> Grading: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File: # - Resolution: # Resolution Date: <br /> Shoreland District: ixA <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 />