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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 9 co Q Lo creN Sr` (;),to <br /> PID: <br /> DESCRIPTION OF WORK: V v)v -r rte) <br /> ZONING REVIEW BY: \_l 0 DATE APPROVED: 1 • 2 7_vo <br /> BUILDING REVIEW BY: go' / I43,;, DATE APPROVED: / 0-z S-cw <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No :. <br /> PLAN REVIEW Yes t- No SEWER CONNECTION <br /> STATE SURCHARGE Yes t/ No W- ATER CONNECTION <br /> INVESTIGATION FEE Yes No P- ARK FEE <br /> SAC Yes No S- ITEINSPECTION <br /> Number of SAC-Units OTHER (specify) <br /> ZONING CHECK LIST Zoning District: a 2-1 6 <br /> Fire Department: (....A3 (SAW Post Office: `i ,(h«. School District: •00. . O • <br /> Lot Area: Sq.ft. NJ G1i-riveyAcres -- Width Depth — <br /> Survey Submitted: Yes No Date of Survey: 7• Lg- 0c) <br /> Proposed Setbacks: <br /> Front(Lake): 1 4 3` 4. Right Side: • 30 <br /> Rear(Street): 17 ` t Left Side: 11510 <br /> Adjacent Structures: Acrro.caf ..97 Wetland: S t <br /> Building Height: Def. Hgt. O.k. Peak Hgt. Os lc- <br /> Lot Coverage: /J )A <br /> Grading: Staff Approval Date: rJ (V'4 By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File: # Resolution: # Resolution Date: <br /> Shoreland District: \ -PS <br /> Avg. Setback: O.K. Bluff Setback: N ( 4 Lot Coverage: tJ(A- <br /> E:tisting Proposed <br /> Existing <br /> Hardcover: 0-75' <br /> 75-250' S' 3 <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variance Required: Yes No pc_ Date of Council Approval: <br /> REMARKS(in house): <br /> 7 <br />