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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: PID: <br /> DESCRIPTION OF WORK: <br /> ZONING REVIEW BY: 1 DATE APPROVED: /494• 2-24.12 <br /> BUILDING REVIEW BY: DATE APPROVED: it "' 22 '42 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes Jr No <br /> PLAN REVIEW Yes—dr No SEWER CONNECTION <br /> STATE SURCHARGE Yes , No WATER CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITE INSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECK LIST Zoning District: <br /> Fire Department: Post Office: School District: <br /> Lot Area: Width: Depth: <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: <br /> Front (Lake) : Right Side: <br /> Rear (Street) : Left Side: <br /> Adjacent Structures: Wetland: <br /> Building Height: Def. Hgt. Peak Hgt. <br /> Avg. 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 /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File:# Resolution #: Resolution Date: <br /> REMARKS (in house) : <br />