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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 33 c> /V o M-r-A S fru' 00. <br /> PID: <br /> DESCRIPTION OF WORK: C) ;Lk <br /> ------------ <br /> ------------------------------- ---- <br /> ZONING REVIEW BY: DATE APPROVED: 4 -'z y-!2!I <br /> BUILDING REVIEW' DATE APPROVED; Q-ZV-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 WATER CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC-Units OTHER (specify) <br /> ZONING CHECK LIST Zoning District: <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes Y_ No Date of Survey: 3-t G • 0 3 <br /> Proposed Setbacks: , <br /> Front(Lake): ZZ40 ''-' Right Side: 1 5S = 5 <br /> Rear(Street): 115 i- Left Side: Z,(5 <br /> � <br /> Adjacent Structures: A7-1Ae_N-67* Wetland: /\/!A <br /> Building Height: Def. Hgt. Peak Hgt. <br /> Lot Coverage: &(#4 <br /> Grading: Staff Approval Date: iJ / /-1 By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File: # — Resolution: # Resolution Date: <br /> Shoreland District: /y 0 <br /> Avg. Setback: Bluff Setback: Lot Coverage: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS(in house): <br /> 7 <br />