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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: <br /> PID: <br /> DESCRIPTION OF WORK: c�l� <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING REVIEW BY: DATE APPROVED: S - 21'c,7 <br /> BUILDING REVIEW BY: DATE APPROVED: s- 7- - 5 <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes No <br /> PLAN REVIEW Yes !/ No SEWER CONNECTION <br /> STATE SURCHARGE Yes c/ No WATERCONNECTION <br /> INVESTIGATION-FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ----------------------------------------------------------------------------------------------------------------------- <br /> ZONING CHECK LIST ZoningDistrict: <br /> Fire Department: AA A Post Office: +� School District: ,re!r,,7T 2r} <br /> Lot Area: Sq.ft. lJo C I Cres Width Depth <br /> Survey Submitted: Yes No nt- Date of Survey: <br /> Proposed Setbacks: <br /> Front (Lake): 3y`' Right Side: <br /> Rear (Street): �,Vo Left Side: (`a <br /> Adjacent Structures: Wetland: /, fL <br /> Building Height: Def. Hgt. Peak Hgt. <br /> Lot Coverage: <br /> Grading: 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 /> 26 <br />