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CHECK OFF LIST FOR ISSiIANCE OF P,�RMITS <br /> F R OFFICE USE NLY <br /> ADDRESS OR LEGAL: � �� <br /> PID: . <br /> � w <br /> DESCRIPTION OF WORK �1yA � �%�Ii c u, S c�c c�-r ci S �_f E C q c,� <br /> �r S h iir -,z. c c�s c� i.s rn c-er�r�e.d ii wu� s�' % <br /> ZONING REifIEW BY.• DATEAPPRO i�ED: ►��`� <br /> BUILDING RET�IEW BY.• DATEAPPROi�ED: '1 -� 9 �� �n.C.�•�c� <br /> u- �s� «����i�� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Y�S ✓ No SEWER CONNECTION <br /> STATE SURCHARGE Yes ✓ No WATER CONNECT'lON <br /> WVESTIGATION FEE Yes No�— PARK FEE <br /> SAC Yes No ✓ SITEINSPECTION <br /> IJumber of SAC Units OTHER (spec�) <br /> ZONING CHECK LIST Zoning District: —�/�' � <br /> Fire Department: Post Office: School District.• <br /> Lot Area: Sq.ft. • Acres � -v� Width <br /> Depth <br /> Survey Submitted: Yes_� No Date of Survey: <br /> Proposed Setbacks: /��rY�l <br /> Frrnn(Lake): Yl G C�"1�}'i�l��� ,Ai�t Side: �/'�0 C�V-►�n�, <br /> � <br /> j.� -��'-�h � . <br /> $ea�(Street): /!Q � 1�fF.Side: jC7 <br /> Adjacent Structures: _n tj Wetland.: /J /�- <br /> Building Height: Def.Hgt. nJ �� Peak Hgt.- - ^�_ <br /> Lot Coverage:_ h� <br /> (�i9'/I'P.��rn�v,�/sc:�i <br /> Grading.• StaffApprovcrT Date: By: ,�?�s{r,:c, Council Approval Date: <br /> Septic: Staff Approval Date: v V � By. �,,/�. <br /> Zoning File: # Resolution: # Resolution Date: <br /> Sleoreland District: MCWD Pei•mit: <br /> Avg. Setback: (�� B1uffSetback: <br /> Lot Coverage: <br /> Fxisting Proposed <br /> Hardcover: 0-75' --��.� �� <br /> 75-250' /�G � 7� (�Z o o�e.5:S �Lw�ri h�►K 1 <br /> 250-500' � � � �Olt /CcS �r y�h� <br /> 500-1000' •— � <br /> Hardcover i�ariance Required.� Yes No ✓ <br /> Date of Council Approval: <br /> REMARKS(in house): <br /> 33 <br />