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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> A,DDRESS OR LEGAL: Zs0 3 kellc� �4.}e _ __ _ __ <br /> PID: <br /> DESCRIPTION OF WORK: �EG� <br /> ZO.�tI�1i G REVIEW BY: DATE APPROVED: 5 -z� .-o y <br /> BUII.DING REV�+`V BY: DATE APPROVED; � -Z� -o� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ./ No <br /> PLAN REVIEW � Yes � No SEWF�CONNEC"TION <br /> STATE SURCHARGE Yes � No WATERCONNECTTON <br /> INVESTIGATION FEE Yes No � PARK FEE <br /> SAC Yes No c/ STTEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZONI�TG CH�CK LIST Zoning District: <br /> Fire Department: Post O�ce: School District: <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes �c. No Date of Survey: ��► � (� <br /> Proposed Setbacks: <br /> Front(Lake): Right Side: <br /> Rear (Sueet): Left Side: n� <br /> � ���!� Q7 V��(g INf� �/�'� <br /> J <br /> Adjacent Structures: Wetland: <br /> Building Heigh[: Def. Hgt. �/ //1 Peal:Hgt. <br /> Lot Covera�e: �/ ��1' <br /> Grading: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning F:le: # — Resolution: !# Resolution Date: <br /> Shoreland District: N� <br /> Avg. Setback: Bluff Setback: L.ot Coverage: <br /> Ezisting Proposed <br /> Hazdcover: 0-75' <br /> 75-250' <br /> 2�0-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> RE�LARKS (in house): ___ <br /> � <br />