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CHECK OFF LIST FOR ISSUANCE OF PERNIITS <br /> FOR OFFICE USE ONLY <br /> ADDRFSS OR LEGAL: l/5 O �',4/1►Je�v Gv�� <br /> ��: <br /> DESCRIPTION OF WORK: o <br /> -------------- --- -------------------------------------------------------------- <br /> ZO�TING REVIEW BY: � N DATE APPROVED: Y-�y �� 3 <br /> BUII�DING REV�W BY: DATE APPROVED: -a <br /> F'EES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ,/ No <br /> pLAN REVIEW Yes _� No SEWER CONNECTION <br /> STATE SURCHARGE Yes _� No WATERCONNECI'ION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> -------------------------------------------------------------------------------------------- <br /> ZO��tG CHECK LIST Zoning District: <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 Se[backs: <br /> Front (Lake): //�� Right Side: 2 S '_'' <br /> Rear (Street): �D' '�" Left Side: Z�7 "�' <br /> Adjacent Structures: z S Wetland: — <br /> Building HeiQht: Def. Hgt. r-- Peal:Hgt. — <br /> Lot Covera�e: � <br /> Grading: Staff Approval Date: — By: Council Approval Da[e: <br /> Septic: Staff Approval Date: — BY� <br /> Zoning File: # —" Resolution: # Resolution Date: . <br /> Shoreland District: /v J <br /> Av�. Setback: Bluff Setback: LotCoverage: <br /> ExistinQ Proposed <br /> a <br /> Hardcover: 0-75' <br /> 75-2�0' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> RE�IARKS (in house): <br /> 7 <br />