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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> � � FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: Z$� I �o� sT <br /> PID: <br /> DESCRIPTION OF WORK: ( ,4,,,,� �,�y��a,.i <br /> ZO.�tI�1i G REVIE`V BY: DATE APPROVED: ,� • 3 • � 2 <br /> BUII.D�G REV�`V BY: DATE APPROVED: <br /> -/------------- �t ----------------------------------------- <br /> FEES TO BE CHARGED:��'°t`'�"� � �Ni° �Fees Ca�lcu ted B �� <br /> isc. y: <br /> PERNIIT Yes �/ No <br /> PLAiv REVIEW Yes No SEWER CONNECTION <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 District: <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres Width Depch <br /> Survey Submitted: Yes�_ No Date of Survey: -1- �2-�) <br /> Proposed Setbacks: <br /> Fron[(Lake): i o• � � Right Side: �''Jo � � <br /> ' , � <br /> Rear (Street): �d � Left Side: z-G a <br /> Adjacent Structures: Sv ` Wetland: �1/> <br /> Building Hei�h[: 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 /> N �i <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 />