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� � CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> A.DDRESSORLEGAL: Z`�01 CASGo Po» �,�,,� <br /> PID: <br /> DESCRIPTION OF WORK: � g x��, (3c2��� �T�o �- �-1 �-�� t.�Ac,lcW A� <br /> --� w��__ _ ------- <br /> --------------------------------------------------------------------- <br /> ZOr11i TG REVIEW BY: � �,,,.._ DAT'E APPROVED: ( f •z5- �� <br /> BUILDI�i tG REV�W BY: �Q DATE APPROVED: i i. 2�•o� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERNIIT Yes l' No <br /> PLA�v REVIEW Yes � No SEWER CONNECTION <br /> STATE SURCHARGE Yes �/ No WATER CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> Z0��1G CH�CK LIST Zoning Distric[: L�2- � �- <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres Width Depth <br /> Survey Submitted: Yes�C� No Date of Survey: S-�-O t <br /> Proposed Setbacks: <br /> F�eat-(Lake): I 0 l� Right Side: �3� } <br /> Rear (Street): '��� Left Side: 23� � <br /> Adjacent Structures: f}���� Wetland: 1N�� <br /> Building Height: Def. Hgt. N�,c� Peal:Hgt. N J/� <br /> L,ot Coveraae: <br /> Grading: Staff Approval Date: —' By: Council Approval Date: <br /> Septic: Staff Approval Date: — By: <br /> Zoning File: # o►-Z.1�S Resolution: # Resolution Date: S2�pz'�`'�� � � <br /> Shoreland District: ��,r,g <br /> Avg. Setback: (9•�z Bluff Setback: �1 I/� L.ot Coverage: <br /> Eusting Proposed <br /> Hardcover: 0-75' <br /> 75-250' 3� Z��y <br /> 250-500' <br /> 500-1000' <br /> Hazdcover Variance Required: Yes v� No Date of Council Approval: �-p� �• �� <br /> REMARKS (in h0use): <br /> 7 <br />