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CHECK OFF LIST FOR ISSUAI�ICE OF PERIVIITS <br /> � FOR OFFICE USE ONLY <br /> � ADDRESS OR LEGAL: �)y c� �A 2iD�s Co��Nt' <br /> PID: <br /> DESCRIPTION OF WORK: o a ( <br /> ZONING REV�W BY: DATEAPPROVED: y-ty-�3 <br /> BUILDING REV�W BY: DAT'E APPROVED: y-i v -� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes � No <br /> pLAN REVIEW Yes c/' No SEWER CONNECITON <br /> STATE SURCHARGE Yes �/ No WATER CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No STTEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ------------------------------------------------------------------------------------------------------ <br /> ZO�TivG CHECK LIST Zoning District: <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres Widch Depth <br /> Survey Submitted: Yes_� No Date of Survey: (-4 <br /> Proposed Setbacks: , <br /> Front (Lake): l 07` � Right Side: SS + <br /> Rear (Street): ( 3J ' + Left Side: �i$ �= <br /> Adjacent Structures: 2`{' Wetland: — <br /> Building Hei�ht: Def. Hgt. — Peak Hgt. — <br /> Lot Covera�e: — <br /> Gradin�: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: — BY� <br /> Zoning File: # —' Resolution: # Resolution Date: . <br /> Shoreland Districr. Nv <br /> Av�. Setback: Bluff Setback: Lot Coverage: <br /> ExistinQ Proposed <br /> a <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> RENIARKS (in house): <br /> 7 <br />