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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR Q�FICE USE ON�Y � <br /> ADDRESS OR LEGAL: �'`�L,�j ���-�._t.���.�: =�- ,T� y� /�Ct-� <br /> PID: -� ��1 - �3 3y o1� <br /> DESCRIPTION OF WORK: —1r��9-�L -�,Gc,��..� � <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING REVIEW BY: DATE APPROVED: Y•Z'7•S4� <br /> BUILDING REVIEW BY: DATE APPROVED: y 2�•gta <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes c/� No <br /> PLAN REVIEW Yes r/' No SEWER CONNECTION <br /> STATE SURCHARGE Yes _� No WATERCONNECTTON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ------------------------------------------------------------------------------------------------------------------------ <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 No Date of Survey: <br /> Proposed Setbacks: <br /> Front (Lake): Right Side: <br /> Rear (Street): Left Side: <br /> Adjacent Structures: Wetland: <br /> �, Building Height: Def. Hgt. Peal: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: <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 />