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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> ' ' FOR OFFICE USE ONLY . <br /> ADDRESS OR LEGAL: Z�i 6 N-o�1 w�n���:� '��✓� <br /> PID: <br /> DESCRIPTION OF WORK: {�,=m,.o v�e� 1L.•-�-�•�-� + ('/��•v Q, �iw�..�� .w L•1... . <br /> _______-------- - ----- ------------------------------------------____ <br /> ZO�TING REVIEW BY: � DATE APPROVED: ti• 3 -v 3 <br /> BUII�DING REV�W BY: DATE APPROVED: y. -z-.3 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> pEgMIT Yes _�� No <br /> pLAN REVIEW Yes �/ No SEWER CONNECTION <br /> STATE SURCHARGE Yes _� No WATERCONNECTTON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SI'TEINSPECTTON <br /> Number of SAC Units OTHER (specify) <br /> ZOr'ING CHECK LIST Zoning District: N� c���P <br /> Fire Department: Post Office: School Disuict: <br /> Lot Area: Sq.ft. Acres dth Depth <br /> Survey Submitted: Yes No ate of Survey: <br /> Proposed Setbacks: <br /> Front(Lake): Right Side: <br /> Rear(Street): Left Side: <br /> Adjacent Structures: Wetland: <br /> Building Height: Def. Hgt. Peak Hgt. <br /> Lot Covera;e: <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: BY: <br /> Zoning File: # Resolution: # R olution Date: . . . <br /> Shoreland Disuict: <br /> Av?. Setback: Bluff Setback: I.ot Coverage: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Vaziance Required: Yes No Date of Council Approval: <br /> REMARKS (in house): <br /> 7 , <br />