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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRFSS OR LEGAL: �f 70 TbAJk&V,4- PID: <br /> I _ <br /> DESCRIPTION OF WORK: Al G-C J k-' <br /> _&��ZONING REVIEW BY: DATE APPROVED G 2 3 <br /> BUILDING REVIEW BY: DATE APPROVED: <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes '� No <br /> PLAN REVIEW Yes v No SEWER CONNECTION <br /> STATE SURCHARGE Yes--P'- 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 /> _____ _ ---------------- <br /> ZONING CHECK LIST Zoning District: <br /> Fire Department: Post Office: School District: 046,V0 <br /> Lot Area: 0Z Width: q 3 'Aut Depth: 7/Y'± <br /> Survey Submitted: Yes < No Date of Survey: t�/aS13 <br /> Proposed Setbacks: )4 <br /> P1 t (Lake) : / !S Right Side: lO <br /> (Street) : 15 Z&(4-4' Lef t Side: 10 ' <br /> Adjacent Structures: A11A Wetland: <br /> Building Height: Def. Hgt. d Peak Hgt. 3&" <br /> Avg. .Setback: V-V= Lot Coverage: <br /> - Existing Proposed <br /> o a► <br /> Hardcover: 0-75 ' _ `_r`; .vw.,tG win/tic 1►2 Y�1 } <br /> 75-250 ' 2 °Tb <br /> 250-500 ' <br /> 500-1000 ' <br /> Hardcover Variance Required: Yes No 1C Date of Council Approval: <br /> Grading: Staff Approval Date: N& A#404404 By: Council Approval Date: <br /> Ape,uw repo x.. A-4 440 c9 <br /> Septic: Staff Approval Date: 4///'} ' By: <br /> Zoning File:#_ *1A — Resolution # : t Resolution Date: <br /> REMARKS (in house) : <br />