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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: i 3 I1 S \I I N t= p c-,-\c-E <br /> PID: <br /> DESCRIPTION OF WORK: <br /> ------------------------------------------------------------- <br /> ZONT'G REVIEW BY: N/11 DATE APPROVED: <br /> BUILDING REVIEW BY: IVDATE APPROVED: 0 -� - <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes No <br /> PLAIN REVIEW Yes ✓ No SEWER CONNECTION <br /> STATE SURCHARGE Yes , NoWATER CONNECTION <br /> INVESTIGATION FEE Yes No—t 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: <br /> Proposed Setbacks: <br /> Front (Lake): Right Side- <br /> Rear (Street): Left Side: j <br /> I <br /> Adjacent Structures: Wetland: <br /> Building Height: Def. Hgt. Ptak Hgt. <br /> i <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 /> 7 <br />