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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: a I(,O W . W A y zAA-T1 (a L J a <br /> PID: <br /> DESCRIPTION OF WORK: -1 i'V A sr SPA GC- ( 'i1 rJ c5Z <br /> ZONING REVIEW BY: 43--,-6 DATE APPROVED: / . 2 8 -o Z <br /> BUILDING REVIEW BY: j DATE APPROVED: -o z <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes t/ No <br /> PLAN REVIEW Yes i/' No SEWER CONNECTION <br /> STATE SURCHARGE Yes No WA I ER CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No V SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECK LIST Zoning District: /Uo Chi-00V <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres idth Depth <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: <br /> Front(Lake): Right Side: <br /> Rear(Street): Left Side: <br /> Adjacent Structures: Wetland <br /> Building Height: Def. Hgt. Peak Hg' <br /> Lot Coverage: <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File: # Resolution: # R-solution 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 />