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� CHECK OFF LIST FOR ISSUANCE OF PERNIITS <br /> ' � FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 3 Z 3'Z C��c.� G���C <br /> PID• �� � /�7 - a 3 � 3 �.�v/3 <br /> DESCRIPTION OF WORK: �L� y�,pp�1,n,�1 <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING REVIEW BY: DATE APPROVED: S- � 3- 5� <br /> BUILDING REVIEW BY: DATE APPROVED: s- i3-S�b <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 WATER CONNEC'ITON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (spec:fy) <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING CHECK LIST Zoning District: <br /> Fire Department: Post Office: School District: <br /> � ( <br /> Lot Area: Sq.ft. Acres Width Depth <br /> � Survey Submitted: Yes n� No Date of Survey: �1� �z ll <br /> L� <br /> Proposed Setbacks: <br /> Ft,�nt (Lake): �3� } Right Side: (C�2.� <br /> ,� ' + � r <br /> &� (Street): � �z Left Side: �� - <br /> Adjacent Structures: ���t,(ft�� Wetland: N k� <br /> Building Height: Def. Hgt. Peal:Hgt. <br /> Lot Coverage: <br /> P, Grading: Staff Approval Date: By: Council Approval Date: <br /> �� <br /> Septic: Staff Approval Date: By: <br /> Zoning File: # ` Resolution: # — Resolution Date: -"- <br /> Shoreland District: .�,c'S <br /> Avg. Setback:�— Bluff Setback: N �/� I.otCoverage: �.f� <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' 2y �� Z�`�'lv <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No 5� Date of Council Approval: <br /> REMARKS (in house): <br /> 7 <br />