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CHECR OFF LIST FOR ISSIIANCE OF PERMITS <br /> �' . FOR OFFICE USE ONLY <br /> , � , ,_� ., . <br /> - - � <br /> _.v. . ...._. <br /> ADD�tES S OR I,EGAL: -:-:..��UD S/f a�L'+�7� ,_... _: � _,-"PID. � -� .,�_.......:_ .._._._::.�-._...�� .� . <br /> . , - - - � : . : <br /> DESCRIPTION OF WORK: �A�►2�p �c��� - <br /> . ------ ------ -- --- --- <br /> --------------- --- ---------------- ------- -- - .__ <br /> . , . , _ <br /> _ . . _ _- -- _.. ._� _. � <br /> ZONING REVIEW BY: DATE "APPROVED: � f"S'� <br /> _ , <br /> _ <br /> ^'u� � � <br /> BIIII.DING REVIEW BY: . _ _ DATB APPROVED: rv ` 'l-3"�� - - __ <br /> --------------------- ------- <br /> FEES TO BE CHARGED: � Misc. Fees Ca].culated 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 � SITE INSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECR LIST -----------------Zoning District---C-�-/�----- <br /> Fire Department: 0 0 fice h o Dis �'ic : <br /> Lot Area: 33 r4c.rx.,� ' t • th <br /> Survey Submitted: Yes � No Date of Survey: o� l=i 1.�; <br /> Proposed Setbacks: < < �- � <br /> �f- (Lake) : ��a f Right Side: (�(� � l�J <br /> �;- <br /> r�+-��-� ; �gp o� � Left Side: `-((�J � t e,.� <br /> �� ��._ <br /> Adjacent Structures: 6� f Wetland: N//4� <br /> Bui J.ding Hei ght: Def. Hgt. c� .(L Peak Hgt. <br /> .�vg. Setback: N�/�- Lot Coverage: N�� <br /> Existing Proposed <br /> Hardcover: 0-75 ' , <br /> 75-250 ' d � <br /> 250-500 ' <br /> 500-1000 ' <br /> Hardcover Variance Required: Yes No� Date of Council Approval: <br /> Grading: Staff Approval Date: N�_ By: Council Approval Date: <br /> Septic: Staff Approva]. Date: BY� <br /> Zoning File:# 19 �6 Resolution � : �i���- � Resolution Date: `�-23 �`t `� <br /> REMARKS (in house) : �,C�3 p L� Tt O NS S!�l�l C'� ? � �-�`? <br />