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_,, . <br /> � � � CHBCR OFF LIST FOR ISSIIANCE OF P$RMITS <br /> ' FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: � / �'' ��1�`1��/i t�� �'PID: <br /> .. � I� �' = � /' <br /> DESCRIPTION OF WORK: � �,'�/k�y1 7 � �� 2��-7 -�' � <br /> ----------------------- ------�.�..-�-------------------------�------------ <br /> ZONING REVIEW BY: DATE APPROVED: 12 -� /I � -f�'CJ <br /> BIIILDING REVIEW BY: DATE APPROVED: �2 ' � 3 ` GI(7 <br /> FEES TO BE CHA.RG$D: Misc. Fees Calculated By: <br /> PERMIT Yes--��� No <br /> PLAN REVIEW Yes ✓i No SEWER CONNECTIDN � <br /> STATE SURCHARGE Yes� No WATER CONNECTION <br /> INVESTIGATION FEE Yes No-� PARK FEE _ <br /> SAC Yes No� SITE INSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ------------------------------------------------------------------------------� <br /> ZONING CHECR LIST Zoning District: L,/Q � / � <br /> Fire Department: <br /> �� Post Office: f' School District: J� <br /> � '-- <br /> Lot Area: / Width: �� Depth: <br /> Survey Submitted: Yes �o Date of Survey: �� �/ - oZla - �d <br /> Proposed Setbacks : t � <br /> Front (Lake ) : �J �U Right Side: v`'-u`� <br /> Rear ( Street ) : -i� Left Side: /� <br /> Adjacent Structures : 1� / Wetland: �— <br /> / <br /> Bui lding Height: Def. ?igt. Peak Hgt. /6 <br /> Avg. Setback: � Lot Coverage: � � <br /> Existing Proposed <br /> Hardcover: G-75 ' <br /> 75-250 ' <br /> 250-500 ' � 3(/ � sa 3 <br /> 500-1000 ` <br /> Hardcover Variance Required: Yes No�Date of Council Approval: ��-- -�/� �lo <br /> Gradingz Staff Approval Date: %� By: �Council Approval Date: �� <br /> Septic: Staff Approval Date: /� By: �"�� <br /> -,�.�-�- fi0 J <br /> Zoning Fi le: # 0 3 Resolution #: Resolution Date:�'�-� 10 -�1� <br /> REMARKS (in house) : <br />