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CHECK FF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: /S-6 Sj (3f,o fo c14-f'5 <br /> PID: <br /> DESCRIPTION OF WORK Ptu_ 5-oc7 /3/L y4,1,95 <br /> ZONING REVIEW BY: DATE APPROVED: 5 4 0 <br /> BUILDING REVIEW BY: DATE APPROVED: <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes V No <br /> PLAN REVIEW Yes No SEWER CONNECTION <br /> STATE SURCHARGE Yes No WALERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> r ZONING CHECK LIST Zoning District: <br /> Fire Department: + Post Office: School District: <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes 1 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 /> Lot Coverage: <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: I By: <br /> Zoning File: # Resolution:# Resolution Date: <br /> Shoreland District: <br /> Avg. Setback: Bluff Setback: Lot Coverage: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75x250' <br /> 250-500' <br /> 50)-1000' <br /> Hardcover Variancd Required: Yes No Date of Council Approval: <br /> REMARKS(in house): <br /> • 26 <br />