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CHECK OFF LIST FOR ISSUA1�tCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 3 S C 2 ys r19� c�c� <br /> PID: <br /> DESCRIPTION OF WORK: �,q s�,�,-.o„�F �-hw�./� <br /> ZO.VI�1i G REV�W BY: ��/� DATE APPROVED: <br /> BUiLD�G RE'VIEW BY: � DATE APPROVED: s• 3� •� c <br /> ----------- ------------_---.--_--------------------------------------------------------------------- <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes � No <br /> PLAN REVIEW Yes �/ No S�VER CO�INECTION <br /> STATE SURCHARGE Yes _� No WATERCO�tNECTION <br /> INVESTIGATION FEE Yes No ✓' PARK FEE <br /> SAC Yes No � SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ---------------------------------------------------------------------------------------------------------------------- <br /> ZONI�IG CH�CK LIST Zoning District: �s,� G_��.•�G <br /> _ � <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sc.ft. Acres Width Dep[h <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: <br /> Front (Lake): Right Side: <br /> Rear (Street): Left Si : <br /> Adjacent Structures: Wetland: <br /> Building Height: Def. Hgt. Peak Hgt. <br /> Lot Covera�e: <br /> Gradina: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File: # Resolution: # Resolution Date: <br /> Shoreland District: <br /> Av�. Setback: Bluff Set ck: L.ot Co��erage: <br /> E�istin� Proposed <br /> � <br /> Hardcover: 0-7�' <br /> 7�-2�0' <br /> 2�0-SOQ' <br /> 500-100a' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> gtEI�qARhS (in house): <br /> � <br />