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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 2 0 Gs W (lac R t-}t L(..5 <br /> PID: <br /> DESCRIPTION OF WORK: 0EC,/c <br /> ------------------------- --- <br /> ZONING REVIEW BY: offfr, DATE APPROVED: /o• -'-a 3 <br /> BUILDING REVIEW BY: DATE APPROVED: 0•Z y <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 is No Date of Survey: ON Fitz Avtif 9 <br /> Proposed Setbacks: <br /> Front (Lake): 1 Syr' t Right Side: 1 I6 3 <br /> Rear (Street): 7)' t Left Side: 4-15 f <br /> Adjacent Structures: A-77,9c.4ie✓ Wetland: n//4 <br /> Building Height: Def. Hgt. N /A- 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: et)J <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 />