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CHECK O.F.V LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: oc\o�9-8,c Qi2o/JO CyzC!-frirr✓ 2 <br /> PID: <br /> DESCRIPTION OF WORK: p,40 ec_ CAI1.2 i"GQ /-ftossi <br /> ZONING REVIEW BY: 1, ,/�� _ — DATE APPROVED: y z6-a6 <br /> BUILDING REVIEW BY: :► DATE APPROVED: y-4.4 -o c <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ,7 No <br /> PLAN REVIEW Yes i/ No SEWER CONNECTION <br /> STATE SURCHARGE Yes No WATER CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No z// 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_4,4_ No Date of Survey: Fi CL <br /> Proposed Setbacks: <br /> Front (Lake)' Zq 31 h Right Side: Z-e>c { 'r <br /> Rear (Str-eet): 1100 / ' Left Side: 2-" <br /> Adjacent Structures: 4/0 Wetland: N/l4 <br /> Building Height: Def. Hgt. /Vo C( Peak Hgt. — <br /> Lot Coverage: N 1A- <br /> Grading: Staff Approval Date: "if f} By: Council Approval Date: <br /> Septic: Staff Approval Date: O •(_cls,,, . 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 /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS (in house): <br />