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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> s , � <br /> ADDRESS OR LEGAL: 4G0 tatNILII PID: <br /> DESCRIPTION OF WORK: �aZ.G(1') <br /> ZONING REVIEW BY: •V DATE APPROVED: 41/ 4/ <br /> BUILDING REVIEW BY: C} DATE APPROVED: 1-1 -2-9 -C U <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes No <br /> PLAN REVIEW Yes No SEWER CONNECTION <br /> STATE SURCHARGE Yes a( No WATER CONNECTION <br /> INVESTIGATION FEE Yes Nom/ PARK FEE <br /> SAC Yes No ✓ SITE INSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECK LIST Zoning District: RE: -/f; <br /> Fire Department: Post Office: School District: <br /> Lot Area:N q5 000 6 Width: 416119 , Depth: WV <br /> Survey Submitted: Yes)( No Date of Survey: 4//1431 <br /> Proposed Setbacks : / <br /> Front (Lake) : Right Side: //7 <br /> Rear (Street ) : 75I Left Side: 55! <br /> Adjacent Structures : Wetland: A Nni►k_ <br /> Building Height: Def. Hgt. /21(0 " Peak Hgt. <br /> Avg. Setback: Lot Coverage: <br /> Existing Proposed <br /> Hardcover: 0-75 ' a <br /> 75-250 ' ----,TI- <br /> 250-500 ' /1t <br /> 500-1000 ' 0 2 o ib <br /> Hardcover Variance Required: Yes No ;‹ Date of Council Approval: <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File:# Resolution #: Resolution Date: <br /> REMARKS (in house) : <br />