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• CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: �,�;.L 1'�i� 1`-��L���°=� <br /> PID: <br /> DESCRIPTION OF WORK: C� ��_,i` <br /> --------------------------------------- --------�-r-----------------------------------------------------------`,--�`-- <br /> ZONING REVI�W BY: -_� {, C�:��---- DATE APPROVED: �1 2 r � � <br /> BUILDING REVIEW BY: ►� ��'� DATE APPROVED: <br /> ---------------------------------------------------------�--�---�r----------------------------------------------------------- <br /> FEES TO BE CHARGED: 3°��6� rM� Fees Calculated B <br /> isc. y: <br /> PERMIT Yes P/ No <br /> PLAN REVIEW Yes No SEWER CONNECTION <br /> STATE SURCHARGE Yes No WATER CONNECTTON <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: f'�`� <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: Z � � = <br /> Rear (Street): Left Side: �a } <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: L.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 /> REMARKS (in house): <br /> 7 <br />