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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> b / I FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: / b 1 /AJ d f Z "Yi /PID: <br /> DESCRIPTION OF WORK: (, Q_ " 1410-14 <br /> ZONING REVIEW BY: \O„ 4!. f DATE APPROVED: -- 7 — <br /> BUILDING REVIEW BY: cc (0Ar AsA,_ DATE APPROVED: 9 - 1 l - 9 0 <br /> FEES TO BE CHARGED: / Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Yes ✓/ No SEWER CONNECTION <br /> STATE SURCHARGE Yes v/ No WATER CONNECTION <br /> INVESTIGATION FEE Yes No i/ PARK FEE <br /> SAC Yes No - SITE INSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECK LIST Zoning District: 44, -- / <br /> Fire Department: Post Office: --` School District: <br /> -- <br /> Lot Area: .f- puf, Width: Depth: .------ <br /> Survey <br /> Survey Submitted: Yes ////I:143 Date of Survey: al • .;), (1) -- `! 0 <br /> Proposed Setbacks : <br /> Front (Lake) : J O *-f Right Side: <br /> ,/ I <br /> 6,6_,(„4,4._ / / �o " 4Fx(s7`6,6- <br /> Rear ( Street ) : `C ! Left Side: H�r S' VA <br /> ScP / Zr Are tcrpia /2esr0exC- - <br /> Adjacent Structures : Wetland: ------, <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 Variance Required: Yes No -ate of Council Approval: <br /> Grading: Staff Approval Date: By: �, Council Approval Date: <br /> Septic: Staff Approval Date: '471/ %O By e/ ���� .C��, � <br /> Zoning File: # Irlrir Resolution # : d4 ,5 '7 Resolution Date: V- - 027-90 <br /> REMARKS (in house) : 0� rt"D co/vAiocl- ( 4& TO L[ To k /.S -,-/ t <br /> ' set-i-.2 (2,rri-pc.41 ° (0 iv fes' 10 (SCck / r-t- <br />