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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> � ADDRESS OR LEGAL: l �,S C�2 y 5��- �,� <br /> ' PID: <br /> DESCRIP'TION OF WORK: �v o � <br /> ZO�tING REVIEW BY: DATE APPROVED: ,S_ �� .oZ <br /> BUII.D�G REVIEW BY: DAT'E APPROVED: S-_��• oz <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERi1�1IT Yes �/ No <br /> PLAN REVIEW Yes �' No SEWER CONNECITON <br /> STATE SURCHARGE Yes � No WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZONING CH�CK LIST Zoning Districr. <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres Width Dep[h <br /> Survey Submitted: Yes X No Date of Survey: phr G'�t� <br /> Proposed Setbacks: <br /> Front (Lake): I`{0� � Right Side: (�O 5 <br /> Rear(Street): � ��� � Left Side: S� � <br /> Adjacent Structures: �' Wetland: �v/�a <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 /> N� <br /> Shoreland District: <br /> Avg. Setback: Bluff Setback: L.ot Coverage: <br /> Ezistin; 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 />