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� CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> � FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: _s`13 � `'r:'�,.�;:�J t. i�;���� ,�_'�='��=? <br /> PID: ' <br /> DESCRIPTION OF WORK: �/L c.,�� /�,,;;= ,-r�.�v ,-L��Z� <br /> _ — __ _ ___________------------------------------------------------------------- <br /> Z0.�1I�1i G RE'VIEW BY: ,r�� ' ,,�_ DAT'E APPROVED: w -;y, � y <br /> BUII.DING REVIEW BY: ,., �; l �,��_ DATE APPROVED: � -r y- �>y <br /> � <br /> --- _______________ --_,____----- ------------------------------------------------------------- <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERiV1IT Yes r/^' No <br /> PLAi�1 REVIEW Yes �/ No SEWER CONNECITON <br /> STATE SURCHARGE Yes I% No WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No STTEINSPECT'ION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CH�CK LIST Zoning District: rt-��: �.--�1r�.�� <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: Wetland: <br /> Building Height: Def. Hgt. Peal:Hgt. <br /> L.ot 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 />