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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> , FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 1 l�c�c� L3 O�-1 t�s PO�►�!T j?o J <br /> PID: <br /> DESCRIPTIONOFWORK: Q��tR� ozu-� C�.���.,�o�S <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING REVIEW BY: /� I/-� DATE APPROVED: <br /> BUILDING REVIEW BY: DATE APPROVED: 3 - z.5 -o� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes J No <br /> PLAN REVIEW Yes No r/ SEWER CONNECTION <br /> STATE SURCHARGE Yes � No WATER CONNECTION <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: /liD G l-�v�-P <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: Wetl d: <br /> Building Height: Def. Hgt. Peak gt. <br /> Lot Coverage: <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: By:� <br /> Zoning File: /t 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 /> � <br /> REMARKS (in house): <br /> i <br /> 7 I <br /> �I <br />