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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESSOR LEGAL: 1 1 L v N•S• <br /> PID: <br /> DESCRIPTION OF WORK: 4�10 4-6 v <br /> ZONING REVIEW BY: DATE APPROVED: N -'z q -u 2 <br /> BUILDING REVIEW BY: — DATE APPROVED: <br /> FEES TO BE CHARGED: (oAP'4` 11isc.�alcula d ry:"� <br /> PERMIT Yes t/ No <br /> PLAN REVIEW Yes No SEWER CONNECTION <br /> STATE SURCHARGE Yes No WATERCONNECTION <br /> WVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECK LIST Zoning District: /v 0 <br /> Fire Department: Post OJNo <br /> School District: <br /> Lot Area: Sq.ft. AcresWidth Depth <br /> Survey Submitted: Yes Date of Survey: <br /> Proposed Setbacks: <br /> Front(Lake):Rear(Street): <br /> Adjacent Structures: NY aland: <br /> Building Height: Def. Hgt. P Hgt. <br /> Lot Coverage: <br /> Grading: Staff Approval Date: y: Council Approval Date: <br /> Septic: Staff Approval Date: y: <br /> Zoning File: # Resolution: # Resolution Date: <br /> Shoreland District: <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 />