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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: gD OLS C STA- 64 y (20.1- <br /> PID: <br /> DESCRIPTION OF WORK: Ai Ew t2eS . <br /> ZONING REVIEW BY: CPL 60/11,40— DATE APPROVED: & •9-9C. <br /> BUILDING REVIEW BY: U cy, d2 w - DATE APPROVED: S-9- ?a, <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Yes £ No SEWER CONNECTION <br /> STATE SURCHARGE Yes 1/ No WATER CONNECTION <br /> INVESTIGATION-FEE Yes No &— PARK FEE <br /> SAC Yes No i— SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECK LIST Zoning District: Re.- l 6 <br /> Fire Department: (Antq (A.K...G Post Office: COY 64-(C.f School District: p!!�� <br /> Lot Area: Sq.ft. Acres Z ACI2e5 ± Width 01. -6LIt.-.47 Depth <br /> Survey Submitted: Yes OC No Date of Survey: -7•30-9 b <br /> Proposed Setbacks: , <br /> Front (Lake): S '' Right Side: 5 V•3 t.. <br /> Rear (Street): 109.3 Left Side: t 30' 'i' <br /> Adjacent Structures: /J 1/4 Wetland: -3( <br /> Building Height: Def. Hgt. 2.0• Peak Hgt. ze <br /> Lot Coverage: /J/A <br /> Grading: Staff Approval Date: 8- 1- i►m By: /20 . Council Approval Date: ,4J09 <br /> Septic: Staff Approval Date: 13 - i- q1 6 By: S.(A-). <br /> Zoning File: # Resolution: # Resolution Date: <br /> Shoreland District: <br /> Avg. Setback: Bluff Setback: Lot Coverage: <br /> Existing Proposed <br /> Hardcover: 0-75' <br /> A 1 f fr , 75-250' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No Date of Council Approval: <br /> MARKS (in house): <br /> 26 <br />