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�- CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: a24,30 W ,ePID: / -H7- 23 '254 436—Y, <br /> DESCRIPTION OF WORK: aLG-ec � <br /> ZONING REVIEW BY: ç' ( COii,w& DATE APPROVED: (2... 2.2.-9 Z <br /> BUILDING REVIEW BY: C nlM- DATE APPROVED: I t"zZ•'i Z <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERT Yes I.7-No <br /> PLANIREVIEW Yeses'' No SEWER CONNECTION <br /> STATE SURCHARGE Yes ✓ No WATER CONNECTION <br /> INVESTIGATION FEE Yes No ✓ PARK FEE <br /> SAC Yes No t SITE INSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECK LIST Zoning District: ( /Q-/(3 <br /> Fire Department: N4h16.0 Post Office: eycs14.-5c+( School District: w95T6v.IKtl <br /> Lot Area: (.L9 glutei' Width: Depth: <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks: <br /> Rite - (Lake) : :3g ' Right Side: .l(A <br /> Rear (Street) : /3611. Left Side: '0' <br /> Adjacent Structures: ti/iJ Wetland: ,V/,4 <br /> Building Height: Def. Hgt. 0 .k Peak Hgt. <br /> Avg. Setback: OA Lot Coverage: <br /> Existing Proposed <br /> Hardcover: 0-75 ' 1`1 .6f1° lit—.90 <br /> 75-250 ' 3-1 `770 37. 5 <br /> 250-500 ' ______itiL ////q <br /> 500-1000 ' <br /> Hardcover Variance Required: Yes )( No Date of Council Approval: g•ZK• 92 <br /> Grading: Staff Approval Date: /V/i4 By: Council Approval Date: <br /> Septic: Staff Approval Date: NM By: <br /> Zoning File:# l7Kb Resolution #: Resolution Date: 8'LY-57- <br /> REMARKS (in house) : <br />