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�'� � CHECR OFF LIST FOR ISSIIANCE OF P$RMITS <br /> FOR OFFICE USE ONLY <br /> /� / /)� <br /> ADDRBSS OR LEGAL: p, C O � � �� G �� 1 ��,Z�/PiD:\ <br /> � <br /> DESCRIPTION OF WORK: ��r�'-�- <br /> ------------------------------------------------------------------------------ <br /> ZONING REVIEW BY: V1ti� DATE APPROVED: � - a S- �7/ <br /> BQILDING REVIEW BY: DATE APPROVED: '� `� -� '�'1 ( <br /> FEES TO BE CHARGSD: Misc. Fees Calculated By: <br /> PERMIT Yes � No <br /> PLAN REVIEW Yes� No SEWER CONNECTION <br /> STATE SURCHARGE Yes� No WATER CONNECTION <br /> INVESTIGATION FEE Yes ✓No � PARK FEE <br /> SAC Yes No c� SITE INSPECTION <br /> Number of SAC Units OTHER (specify) , d,,A f,� <br /> ZONING CHECR LIST Zoning District: �„ � - ( C_ <br /> Fire Department: �"� Post Office: /'`-School District: `�- <br /> Lot Area: �Q , /„ �5,,� Width: Depth: <br /> -T <br /> Survey Submitted: Yes � No Date of Survey: �3- -/S-�y , ��l-�'7- �O <br /> Proposed Setbacks: / <br /> Front (Lake) : �y Right Side: 2 0 � <br /> Rear ( Street) : Left Side: <br /> l� � <br /> Adjacent Structures : �� Wetland: --'—� <br /> Building Height: Def. Hgt. ------ Peak Hgt. -�� <br /> / �'�` 3,G1 Q.'7S�/ �'�. /S� <br /> Avg. Setback: 't'(-�'"�`'��••�� Lot Coverage: 3 5 03,�.a,( �/�---�/6.f <br /> �E ' s i g Proposed � <br /> ,�� <br /> Hardcover: 0-75 ' C.- `�- <br /> 75-250 ' 7 � O �f, �S� S'9'� ' . S�S.s�01. ��10 <br /> 250-500 ' G- �- <br /> 500-1000 ' <br /> Hardcover Variance Required: Yes�No Date of Council Approvalr /z--l0 --9a <br /> Grading: Staff Approval Date: �- By: �Council Approval Date: <br /> Septic: Staff Approval Date: � By: <br /> Zoning File: # �r��� Resolution #: o�, y/S Resolution Date:�L. -/6 - QO <br /> (in hou e) <br /> ��c �� � ! �7 3 c? l,3 /}'-� Q. ..e-,�� ►�o�-�.a.�......!i���o,..c.r <br /> ~ ��-�-' ,�. ��2���-i - yi � <br /> , _ <br />