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CHECK OFF LIST FOR ISS UANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: �j?JS 451�1�i�S� <br /> PID: <br /> DESCRIPTION OF WORK EfiU <br /> ---------------------------------------------------------------------------------------------------------------- <br /> ZONING RE vIEW BY.• DATEAPPRO vED: ��ZL��� <br /> BUILDING REVIEW BY: DATEAPPROVED: 1-z9-0 7 <br /> FEES TO BE CHARGED: / Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Yes r� No SEWER CONNECTION <br /> STATE SURCHARGE Yes J No WATER CONNECTION <br /> INVESTIGATION FEE Yes No ✓ PARK FEE <br /> SAC Yes No (� SITEINSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZONING CHECK LIST Zoning Distr•ict: ��� <br /> Fir•e Depar•hsrent: Post Offrce: Sehool District: <br /> Lot Ar•ea: Sq.fi.�Z�� Acres �' � � Width/y� � - 1 Depth <br /> Sauvey Submitted: �'es No X Date 1 of Sur ey: �� � <br /> �� <br /> Propose����cks: I¢�Nt�'i/1 hCi�..E%' y� <br /> ront Lake): + `6"d' ��Side: I Z-(� <br /> / ,�, <br /> Re�,�Street):���/ �e: �U N��� .�� . <br /> . � <br /> Adjacent Strirctu��es: Wetland: �%'��' '��YDY1� �%,�,� ��"� � � <br /> N , wt dln vtdl �C�1 a"� <br /> l3irildrng Hei,ght: Def Hgt. 1� Peak Hgt. <br /> Lot Cover•age: �� � �'�l�'�' 1- ��' C1�� `' <br /> � <br /> G�•ading: StaffApproval Date: %�� By: C'ouncil.4pproval Date: <br /> Septic: StuffAppr�oval Date: �" ,�Q� 6y:��- <br /> 7_onir�g File: #��_ Resolution: ri Resolution Date: <br /> Shor•eland Dist��ict: � �i�fCG�'D Permit: <br /> Avg. Setbuck: Bla ff Setbac%: Lot Coverage: - <br /> Existrng Proposed <br /> Har•dcover: 0-7.i' <br /> 7.5-2.50' <br /> ?sn-soo� <br /> sr�o-�oon� <br /> I-far•dcover Vai�iance Reyzrired: }es ,�'o� Date of Co��ncil,�lppi�oval: <br /> REMARKS(in liocrse): <br /> 33 <br />