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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 2' ) (Ato-c9) (4/ - 40470 <br /> FID: <br /> DESCRIPTION OF WORK: S ¢-- /1.tsirct+%fr k.).-104-414 <br /> ZONING REVIEW BY: DATE APPROVED: <br /> BUILDING REVIEW BY: /c( DATE APPROVED: (,(9 -1 2"II <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes t/ No <br /> PLAN REVIEW Yes '-- No SEWER CONNECTION <br /> STATE SURCHARGE Yes i/ No WATER CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No STTEINSPECTION <br /> Number of SAC-Units OTHER (specify) <br /> ZONING CHECK LIST Zoning District: Aiv Gr 7 O d — G4C.• <br /> Fire Department: Post Office: r School District: <br /> Lot Area: Sq.ft. Acres Width 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: Wet d: <br /> Building Height: Def. Hgt. Peall Hgt. <br /> • <br /> Lot Coverage: <br /> Grading: Staff Approval Date: B Council Approval Date: <br /> 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 />