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CHECK OF'F LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> AU!DRESS OR LEGAL: �7 Zo �1nv,L��/ �A,�j,�,t,� /lo,e�o <br /> PID: <br /> DESCRIPTIOV OF WORK: c.U� <br /> ZONI�TG REVIEW BY: DATE APPROVED: /o-�3-o r <br /> BUILDIl�i G REV�W B : DATE APPROVED: �a -r 3 -o S— <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ,/� No <br /> PLAN REVIEW � Yes �/' No SEOVER CONNEC"ITON <br /> STATE SURCHARGE Yes .� No WATERCONNECTTON <br /> INVESTIGATION FEE Yes No �/ PARK FEE <br /> SAC Yes No � STTEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ZOt�T��TG CH�CK LIST Zoning District: <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sc.ft. Acres Width Depth <br /> Survey Submitted: Yes � No Date of Survey: o�v t=��..� <br /> Proposed Setbacks: <br /> Front(Lake): i��� t' Right Side: �Z�� � <br /> Rear(Street): i�Q � t Left Side: � ,0 � �'� <br /> Adjacent Structures: q.�q� Wetland: N I rp. <br /> Building Height: Def. Hgt. Feal:Hgt. �- <br /> Lot Covera?e: /J f� <br /> Gradino: Staff Approval Da[e: r-- By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # — Resolution: # Resolution Date: <br /> Shoreland District: /va <br /> Avj. Setback: Bluff Setback: LotCovera?e: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 2�0-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS (in house): <br /> � <br />