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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRE6SORLEGAL: �7y5" �iFSw ���� ��+n <br /> PI1:): <br /> DESCRIPTION OF WORK: (I,�;�wnL L <br /> ----------- ---------------- - <br /> ZO�TING REVIEW BY: DATE APPROVED: ti - 3 -0 5 <br /> BUILDING REV�W BY: DAT'E APPROVED: y • 3 -a 3 <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 CONNECT'ION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ----------------------------------------------------------------- M,�4N <br /> ZOti�Il�1G CHECK LIST Zoning Disuict: M a G � <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres idrh 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:Hg . <br /> Lot Covera�e: <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: BY� <br /> Zoning File: # Resolution: # solution Date: <br /> Shoreland District: <br /> Av�. Setback: Bluff Setback: I.ot 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 /> REviARKS (in house): <br /> 7 1 <br /> i <br />