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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: _ 1 p 5� c�x �A r�.w. (�.o r� <br /> PID: <br /> DESCRIPTION OF WORK: C,�,y�� �p� � a N � n/ b r+�tl�c� <br /> ZO.�I�1i G REVIE`V BY: � DATE APPROVED: <br /> BUII..DING REVIE`V BY: DATE APPROVED: <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Yes ✓ No SEWER CONIVEC"ITON <br /> STATE SURCHARGE Yes �/ No WATER CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPEC'I'ION <br /> Number of SAC Units OTHER (specify) <br /> --------------------------------------------------------------------------------------------------------------------- <br /> Z0�1Pi 1G CH�CK LIST Zoning District: �v o C l-F-�q,��c�e <br /> O <br /> Fire Department: Post O�ce: School District: <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: <br /> Front (Lake): Ri� Side: <br /> Rear (Street): Left ide: <br /> Ad;acent Structures: Wetland: <br /> Buildin� Heioht: Def. Hgt. Peak Hgt. <br /> Lot Covera�e: <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: Blu f Setback: I,ot Coveraje: <br /> Ezi ting Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 2�0-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REI�IARKS (in house): <br /> 7 <br />