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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> .FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 4t2S -T k A\A(4 <br /> PID: r <br /> DESCRIPTION OF WORK: ©o <br /> ---------------------------------------- ------------------------------------------------------------------------------ <br /> ZONING REVIEW BY: DATE APPROVED: <br /> BUILDING REVIEW BY: DATE APPROVED: • 2.l—� co <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes l/' No <br /> PLAN REVIEW Yesy' No SEWER CONNECTION <br /> STATE SURCHARGE Yes No WATER CONNECTION <br /> INVESTIGATION FEE Yes No t-- PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING CHECK LIST Zoning District: X12-I1� <br /> Fire Department: Post Office: School District: 01l_CNO <br /> Lot Area: Sq.ft. AMAcres Width Depth <br /> Survey Submitted: Yes K No Date of Survey: Ons P l - <br /> Proposed Setbacks: <br /> Fit (Lake): Ztb3 Right Side: /V/A <br /> Dear (Street): Z.S Left Side: 26 i <br /> Adjacent Structures: 10 k Wetland: OU/14 <br /> Building Height: Def. Hgt. �Af(14 Peak Hgt. /V(/4 <br /> Lot Coverage: Al IA- <br /> Grading: <br /> 'Grading: Staff Approval Date: By- Council Approval Date: <br /> Septic: Staff Approval Date: /4RL/olutio . #Zoning File: # Resolution Date: <br /> Shoreland District: <br /> Avg. Setback: 0,4 Bluff Setback: /y JA <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 /> 10 <br />