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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: (110 (,V,n o c df( PID: <br /> DESCRIPTION OF WORK: ) C9A244-& <br /> ZONING REVIEW BY: ,�n.._ DATE APPROVED: (0-15-c2 <br /> BUILDING REVIEW BY: S1 DATE APPROVED: (y -1‘5'41 2 <br /> FEES TO BE CHARGED: �1 Misc. Fees Calculated By: <br /> PERMIT Yes No <br /> PLAN REVIEW Yes-77. No SEWER CONNECTION <br /> STATE SURCHARGE Yes ' No WATER CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No ✓ SITE INSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING cuECK LIST Zoning District: /12-)tS <br /> Fire Department: 00,45r t,,41w Post Office: C/L/J (- 6* School District: N/c. <br /> Lot Area: 23) 1.1 Width: 410 &Oi'� Depth: 2_1(.. .6/ I <br /> Survey Submitted: Yes / No Date of Survey: g, -1( - �5- <br /> (' <br /> Proposed Setbacks: r <br /> Front (Lake) : 'yin Right Side: <br /> LA_ <br /> Rear (Ctrcct) : /eg1 = Left Side: Z=( 1 1 <br /> Adjacent Structures: 10 ' Wetland: /vIA <br /> Building Height: Def . Hgt. 0 . 14- Peak Hgt. <br /> Avg. Setback: Lot 'overage: <br /> Ex' ing Pr.posed <br /> Hardcover: 0-75 ' <br /> 75-250 ' <br /> 250-500 ' <br /> 500-1000 ' <br /> Hardcover Varia ce Requ red: Yes No D=te of ouncil Approval: <br /> Grading: Staff Approval Dat: : By: Co ncil Approval Date: <br /> Septic: Staff Approval 'at - : :y: <br /> Zoning File: ' •esoluti,n #: esolution Date: <br /> REMARKS (i. house) : <br /> A 111111111111111011111111111 <br /> 11110111111. <br /> \ <br />