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• CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESSOR LEGAL: (o e O W j I(ow OR E. <br /> PID: <br /> DESCRIPTION OF WORK: ;SHeo <br /> --------- <br /> ZONING REVIEW BY: DATE APPROVED: _d <br /> BUILDING REVIEW BY: DATE APPROVED: z• 3-c <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 WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SI TEINSPECTION <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 X No Date of Survey: (o--30- 04 <br /> Proposed Setbacks: <br /> Front(I-ake): Soy Right Side: 335 Z <br /> Rear(&;eet): Is$, Left Side: 3Q0 ± <br /> Adjacent Structures: Wetland: 2 to <br /> Building Height: Def. Hgt. _ p,1c- Peak Hgt. -- <br /> Lot Coverage: /V 114 <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File: # Resolution: # Resolution Date: <br /> Shoreland District: ti-e5 , <br /> Avg. Setback ,✓t A Bluff Setback: Lot Coverage: zA . <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' , /C <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No_� Date of Council Approval: <br /> REMARKS (in house) <br /> 7 <br />