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CHECK OFF LIST FOR ISSUAINCE OF PERtiIITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS ORLEGAL: .�/5 Al PID: DG-//7- ?3 Iy ooa� <br /> DESCRIPTION OF WORK: <br /> ZO`TP G REN=V BY: 4� DATE APPROVED: 57-/S'-9& <br /> BUILDEI G R.EV�tiV BY. © Nl/¢ DAVE APPROVED: <br /> ms`s. Fees Calculated By: <br /> FEES TO BE CIiA.RGED: 8' <br /> PERv1IT Yes No <br /> PLAN REVIEW Yes SEWER CONNECTION <br /> STATE SURCHARGE Yes No WATER CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SI:,,C Yes No SITE INSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ----------------------- ZoninDistrict: Shore?and District : ye-5 <br /> ZONU\G CHECK LIST 2 ' <br /> Fire Department: <br /> Post Office: School District: <br /> Lot Area: Sq.fr. Acres <br /> Depth <br /> Survey Submitt Yes No Date of Survey: <br /> Proposed Setbacks: <br /> Front (Lake): Right Side: <br /> Rear (Street): Left Side: <br /> Adjacen S ructures: Wetland: <br /> Building Height: D . Hat. ,- ,e H=t. <br /> Avg. Setback: Bluff etback: t Cove ge: <br /> Exis ing oposed <br /> Hardcover: 0-75' <br /> 75-25 ' <br /> 250-50 <br /> 500-10 0' <br /> Hardcover ariance Req iced: Ye No D `e of Council Appr val: <br /> Grading: Staff Approval Date: By: Council Aopro al Date: <br /> Set)tie: taff Approval D <br /> Zonins File: # Resolution: n Resolution Date: <br /> REN (in ho <br /> 26 <br />