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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: Z4q ZS OuU r3G(4C.H <br /> PID: <br /> DESCRIPTION OF WORK: O`,cir,- <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING REVIEW BY: DATE APPROVED: I• ZZ- 9,7 <br /> BUILDING REVIEW BY: DATE APPROVED: 7-ZZ--17 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Yes i,— No SEWER CONNECTION <br /> STATE SURCHARGE Yes t/ No WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Y::s 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 /> Survey Submitted: Yes V- No Date of Survey: On! !'=t <br /> Proposed Setbacks: I �. <br /> Front (Lake): _ (.3 Right Side: '230 + <br /> Rear (Street): 3(-1 1 } Left Side: %S' t <br /> Adjacent Structures: ATT-Ac- Wetland: <br /> Building Height: Def. Hgt. Peak Hgt. <br /> Lot Coverage: <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File: # Resolution: # Resolution Date: <br /> Shoreland District: <br /> Avg. Setback: AltA- Bluff Setback: Al 0- Lot Coverage: /VJA- <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' U �� <br /> 500-1000' <br /> Hardcover Variance Required: Yes No D<, Date of Council Approval: <br /> REMARKS (in house): <br /> 26 <br />