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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: H00 Cx.74 r' �• <br /> PID: <br /> DESCRIPTION OF WORK: o I <br /> ZOVI�t 1G REV�W BY: .�.•. DATE APPROVED: �•L i-o y <br /> BUII�DING REVIEW BY: DATE APPROVED: -�•z�-,s" <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW � Yes ✓' No SEWF12 CO�tNEG"ITON <br /> STATE SURCHARGE Yes � No WATERCONNECTION <br /> INVESTIGATION FEE Yes No �' PARK FEE <br /> SAC Yes No i/ SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZONI�i TG CIi�CK LIST Zoning District: <br /> Fire Department: Post Office: School District: � <br /> L,ot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes_� No Date of Survey: p�r /s, O y <br /> Proposed Setbacks: <br /> Front(Lake): /`1S� t Right Side: T� ` <br /> Rear(Street): (�o� f Left Side: / ZO� f- <br /> Adjacent Structures: io' Wetland: N/�4 <br /> Building Height: Def. Hgt. O�K Peal:Hgt. l�K <br /> Lot Covera�e: N I✓� <br /> Gradino: Staff Approval Date: — By: Council Approval Date: <br /> Septic: Staff Approval Date: " By: <br /> Zon.ing File: # — Resolution: # Resolution Date: <br /> Shoreland District: /v �� <br /> Avg. Setback: Bluff Setback: Lot Coverage: <br /> Ezisting Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 2�0-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Da[e of Council Approval: <br /> RENIARKS (in house): <br />