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! <br /> � � CHECK OFF LIST FOR ISSUANCE OF PERIVIITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 39 � NaR7"H �CCC�2nr/�A c,C <br /> PID: <br /> DESCRIP'TION OF WORK: o e l ��se <br /> ------------------------------------------------- --------------------------------------------------------------------- <br /> ZONING REVIEW BY: DATE APPROVED:�� -a - c� <br /> BUILDING REVIEW BY: DATE APPROVED: 2-2--� <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes �' No <br /> PLAN 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 /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING CHECK LIST Zoning District: a-R �� <br /> Fire Department: �7,�t- a- Post Office: W � School District: �„j�}.y-��q.��3 <br /> Lot Area: Sq.ft. �o CN�t,•�c,,� Acres Width Depth <br /> Survey Submitted: Yes e� No Date of Survey: onr (=i t.V <br /> Proposed Setbacks: <br /> Front (Lake): �36 0 � � Right Side: 5"70� <br /> Rear (Street): d� � � Left Side: �b� <br /> Adjacent Structures: /S � Wetland: N/� <br /> Building Height: Def. Hgt. �/��' Peak Hgt.wl� <br /> Lot Coverage: �//r¢ <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File: # Resolution: #f Resolution Date: <br /> horeland District: <br /> N,{" Avg. Setback: Bluff Setback: L,otCoverage: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> REMARKS (in house): <br /> 7 <br />