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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> 7-� �3 :3� 6 0 a <br /> ADDRESS OR LEGAL: �� 3� PID: 61-// <br /> :— <br /> DESCRIPTION OF WORK: IV ELS &AtzA&,6 )ZED ooFAA.�,,Q- SNCL rtruisH 0,47 �4 <br /> ------------------- - ---------=----------------------------------- <br /> - - ------ <br /> ZONING REVIEW BY: - -- DATE APPROVED: S; 'Z -°l l( <br /> BUILDING REVIEW BY: DATE APPROVED: S"2-9 -( <br /> ----------------- <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Yeses No SEWER CONNECTION <br /> STATE SURCHARGE Yes- t-;� No WATER CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITE INSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ------------------------------------------------------------------------------ <br /> ZONING CHECK LIST Zoning District LA-16 <br /> Fire Department: Post Office: /VL.o,,N.O School District: Z-7"7 <br /> Lot Area: gzcfoo55 ;* t Width: VAaa�s Depth: t/ ►cb <br /> Survey Submitted: Yes _ No Date of Survey: -7-((.- <br /> Proposed <br /> 7-f(.-Proposed Setbacks: <br /> Front (Lake) : N D -J- Right Side:- k)if} <br /> Rear (Street) :— Sq t Left Side: 13 14- <br /> CwD <br /> Adjacent Structures: to Wetland: /V104- <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 VarianrReq : Yes No� Da a of Council Approval: <br /> Grading: Staff Ae: BY:, Council Approval Date: <br /> r <br /> Septic: Staff Ap : ' By: <br /> Zoning File:# esolut' n #: Resolution Date: <br /> REMARKS (in ho se) : <br />