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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> ' FOR OFFICE USE ONLY <br /> � ADDRESS OR LEGAL: , ��:� I ��;t�-c.�:_ CLc�-- <br /> PID: ` - �� � . � � ,�3 c�i� <br /> DESCRIPTION OF WORK: �e_ .�' y,. `� <br /> ---------------------------------------------------------------------------------------------------------------------- <br /> ZONING REV�W BY: IU DATE APPROVED: <br /> BUII..DING REVIEW BY: � DATE APPROVED: b- 3- �� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Yes ✓ No SEWER CONNECTION <br /> STATE SUR�HARG� Yes �' No WATER CONNECTTON <br /> INVESTIGA'I'ION-FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING CHECK LIST zoning District: <br /> Fire Department: Post Office: School District: <br /> �Lot Area: Sq.ft. Acres Width Depth <br /> iSurvey Submitted: Yes No Date of Survey: <br /> IProposed Setbacks: <br /> � Front (Lake): Right Side: <br /> Rear (Street): Lefr Side: <br /> ; Adjacent Structures: Wetland: <br /> i <br /> Building Height: Def. Hgt. Peak Hgt. <br /> N � Lot Coverage: <br /> ; Grading: Staff Approval Date: By: Council Approval Date: <br /> � Septic: Staff Approval Date: By: <br /> Zoning File: # Resolution: # Resolution Date: <br /> , � <br /> � Shoreland Dist:ict: <br /> IAvg. Setback: Bluff Setback: Lot Coverage: <br /> , Existing Proposed <br /> �'�i Hardcover: 0-75' <br /> I 75-250' <br /> �; 250-500' � <br /> I 500-1000' <br /> � <br /> � Hardcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS (in house): <br /> • 26 <br />