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, , CHECR OFF LIST FOR ISSIIANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDR$SS OR LEGAL: 3l o a /<�/��G�d o e� C•!� PID: <br /> DgSCRIPTION OF WORR: /��! �V''� � `^'�����` <br /> -------------------- - -- ------------------- <br /> ---------------------------------- <br /> ZONING REVIEW BY: DATB APPROVED: (�-r� j�'Y <br /> BDILDING REVIEW BY: DAT$ APPROVED: � Z'� -�'� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes v No <br /> PLAN REVIEW Yes �No SEWER CONNECTION <br /> STATE SURCHARGE Yes � No WATER CONNECTION <br /> INVESTIGATION FEE Yes No v^ PARK FEE <br /> SAC Yes No—�-'� SITE INSPECTION <br /> Number of SAC Units OTHER ( specify) <br /> ------------------------------------------------------�-J ----/-�-------------------- <br /> ZONING CHECR LIST Zoning District: /` 2� ?r� <br /> Fire Department: Post Off ' ce: hoc�, Distr.ict: <br /> Lot Area: idth: ep <br /> .� <br /> Survey Submitted : Yes O'� No Date of Survey: o� �� 1..� �" �� � � <br /> Proposed Setbacks : � � <br /> Front (Lake ) : 2� +' Right Side: � /2.�{ <br /> Rear (Street) : N�14 Lef t Side: ���4 <br /> Adjacent Structures: ,C}.-T77¢C-E{G� Wetland: � ��' <br /> BuiJ�ding Height: Def. Hgt. JV �IE1' Peak Hgt. <br /> Avg. Setback: Lot Cover ge: <br /> Exist ' ng Propose <br /> Hardcover: 0-75 ' <br /> 75-250 ' <br /> 250-500 ' <br /> 500-1000 ' <br /> Hardcover Variance equir . es No D te of Cou cil Approval : <br /> Grading: Staff Ap oval D te: y: Counci Approval Date : _ <br /> Septic: Staff Ap rovaJ� Da e: y: <br /> Zoning File: # e olution # : Res lution Date: <br /> REMARKS (in ho se) : <br />