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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: Z L t c� ww0� (L,dc�t <br /> PID: <br /> DESCRIPTION OF WORK: �'oA��e �-,OD ,�-�v�/ -t 5'�•�5 <br /> --------------------------------------------------5----- <br /> ZO�tIiYG REV�+W BY:—~ ����� DATE APPROVED: �v-z�- o <br /> BUILDII`G RE`VIEW BY: DATE APPROVED: ��•z,-o� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT 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� STTEINSPECTTON <br /> Number of SAC�Units OTHER (specify) <br /> ZONI�IG CHE.CK LIST Zoning District: <br /> Fire Department: Post O�ce: School District: <br /> Lot Area: Sc.ft. Acres Width Depth <br /> Survey Submitted: Yes yC No Date of Survey: q•(�{-�l� o�v ��� <br /> Proposed Setbacks: yt1A �,o A�r�� <br /> Front (Lake): I ' 33 ' Right Side: y0 � 1�b� '� <br /> Rear (Street): '15� 3� Left Side: c fl�, ti�'� ' � <br /> Adjacent Structures: �¢�� Wetland: �/I�- <br /> Building Heig,ht: I'ief. Hgt. Q,k Peal:Hgt. -- <br /> Lot Covera�e: �•� <br /> Gradino: Staff Approval Da[e: '� By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # — Resolution: # Resolution Date: <br /> Shoreland District: <br /> Av�. Setbac : n.� Bluff Setback: /J (�- Lot Covera�e: — <br /> Existin� Proposed <br /> Hardcover: 0-75' <br /> 75-250' z�.s�t z 3•2�l <br /> 2�0-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No vc.- Date of Council Approval: <br /> REMA.RKS(in house): <br /> � <br />