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DESCRIPTIOl�I OF IfOR1C a�f✓[f B;r �L�'..r'�`•r'i.+�' L LJ�;�I'�1�:. /��r• .;i�ir�v
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<br /> :.y-� ---------------- ---- -------DATS AYPROV�: �'Z'-g / ��---------- �;
<br /> �OIIII/G BSvIEK SY? - --
<br /> 4 ;�. , .:.:', ... . .. . L.
<br /> �� ..
<br /> �II.DIIIG RSVI$M BY: : • Dl1TB APPRaV�: � -02 � _ �/Cj ,...
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<br /> pBRMIT�'ISSII� BYs DATB: =:
<br /> �gg Sp gg��gp: --y---------Misc. Fees Calculated By:_�------------ ���
<br /> . „ .
<br /> _
<br /> tf�¢. � :; . ; � : . . � . _ _
<br /> S����` � �° � . _ . _ . . .
<br /> jt .i . �� . �� n-�_�.�- �yC
<br /> No ._._.,�,n-5EWER UNIT----� - --$ __ _.-..
<br /> �T�..•s��.��Yese-...• 4,>
<br /> �,___ .
<br /> �-���;.
<br /> 'p'� ggVlgW . '.Yes'�No_ SEWER CONNECTION """ ^�-�
<br /> �a �.... - . . �
<br /> STATE SURCHARGE Yes No WATER CONNECTION X`
<br /> �.
<br /> _�v�r , , , �— � � ��.
<br /> `ENALTY's . Yes_ No � PARR FEE �
<br /> �. t� � '�-.
<br /> SAC �' Yes No� SITE INSPECTION _ �s
<br /> \3: � .. ... � . �. . , . �,t
<br /> � ::�.� , _ _ OTHER (specify) � �
<br /> O11ING:CSECR LIST------------------Zoning District: �l�- � � ------------------- �,
<br /> ;� _ .
<br /> Fi e Department.� Post Office:�^�LO��r� School District:�O�t.N�
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<br /> �;,e � M/
<br /> R� : - � �3_�-G --Width:�v� �o I _ _ Depth: IQ V G Z�_j � - -�
<br /> t Area: �
<br /> �u� f -Z� ` �9
<br /> �Survey.Submitted: `Yes� No_ Date of Survey: �
<br /> ��;'�~" ,� �; ?.._; • ._ :. _
<br /> P posed Setbacks:
<br /> `f� 4 /' ._ : ��,� � ���G. Sr�r���_ OK
<br /> '��:` _.�Fs�at (Lake): Right Side• 22+
<br /> ;,, '
<br /> / � �
<br /> � .�- (Street):. . ;.,71 I.eft Side:�� 1 F�
<br /> ,�, _:� ,,.�... �.�, . . .>_�:. -
<br /> s� Ad)acent Structures: ""''-�- Wetland: �""�"�""�
<br /> s'�` Existinq Proposed
<br /> e:Y 3 '.� < �- .-� , . �
<br /> ,. � � ' >' NoN F
<br /> Sardcover 0-75 . NbN� ':
<br /> ,�� . 3,� . . ` e _ 2�'� �� k.
<br /> � �'= "75-250' t o � �
<br /> �
<br /> � � �
<br /> ��` "' ;
<br /> Hardconer.Variance Required: Yes_ No� Date of Council ;pproval:
<br /> ��,�� , �,.- =
<br /> Gradirig Staff Approval;;Date: NONE By��� Council Approval Date: "
<br /> ��� �;
<br /> �4�
<br /> &eptics .Staff;Appzoval�Date: ` � — BY= �'
<br /> -.�� i ..._; �,,. , , .�. .:., . -. r:�.. •,., �;�� .. � . . � .
<br /> oning,File � �� � ' Resoluti�n #: '�"—"'-- ResoluLion Date:
<br /> ��a�i�iis�t in;honse):�r°�1G4�V�1`",i�i c.t,..��3�"/2-�v��C� N,�rr.D c�V��. ?a T#�
<br /> _ �'����L �� o Ncv"'1SS�•t� P�wt1T I�tNTY�-- iKl'G Vt-'�ZIFI�YS 77d���"
<br /> A�DG���t�R:` �rA�S ' l��'`-QVf� �
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