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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 53 3Q t t G t,,,..) d <br /> PID: <br /> DESCRIPTION OF WORK: t C-l� <br /> ZONING REVIEW BY: ;,A/ dI DATE APPROVED: 5-. - O i <br /> BUILDING REVIEW BY: W Y DATE APPROVED: 5 - �Z <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes No <br /> PLAN REVIEW Yes c/ 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 pc. No Date of Survey: /-,' . 0 2... <br /> Proposed Setbacks: _ <br /> Front (Lake): /' , Right Side: 10 <br /> Rear(Street): I -IO Left Side: GO <br /> Adjacent Structures: ATTIqCt✓) Wetland: giy <br /> Building Height: Def. Hgt. /V ( Peak Hgt. <br /> Lot Coverage: <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> A- 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 />