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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 1 O►0 W Lc.Ousv 1 w V)2 <br /> PID: <br /> DESCRIPTION OF WORK: Pod l <br /> ZONING REVIEW BY: ( --- DATE APPROVED: 9-g -os <br /> BUILDING REVIEW BY: (QA, -- DATE APPROVED: cr -5' -6 S- <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes c/ No <br /> PLAN REVIEW Yes c/ No SEWER CONNECTION <br /> STATE SURCHARGE Yes t✓ 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: Sc.ft. Acres Width Depth <br /> Survey Submitted: Yes y[ No Date of Survey: ON t='i l.tT <br /> Proposed Setbacks: <br /> Front (Lake): 1 10 I ± Right Side: i <br /> Rear (Street): 100' { Left Side: i 0 ` 4 <br /> Adjacent Structures: 10 ' Wetland: 30' 3 <br /> Building Height: Def. Hgt. Peak Hgt. <br /> Lot Coverage: N - <br /> Grading: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # — Resolution: # Resolution Date: <br /> Shoreland District: �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 />