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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> 4 p yF/ORO/FFIC/E USE ONLY <br /> ADDRESS OR LEGAL: q� ( 0 /Lic x I �`l Oy,,- D: <br /> DESCRIPTION OF WORK: ce-k- <br /> ZONING REVIEW BY: �i(o(�iyw— ----------DATE APPROVED:---3-�`1 -�I l-------------- <br /> BUILDING REVIEW BY: DATE APPROVED: 3 '1 C, -k <br /> ---------------------- <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes V"' No <br /> PLAN REVIEW Yesy No SEWER CONNECTION <br /> STATE SURCHARGE Yes &--* No WATER CONNECTION <br /> INVESTIGATION FEE Yes No c/ PARK FEE <br /> SAC Yes No !/ SITE INSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ----------------------------------------------------------------------------- <br /> ZONING CHECK LIST Zoning District: <br /> Fire Department: / okO Post Office: /LWyAv/J School District: /yrawAvO <br /> Lot Area: 6 .(4 2 /}-C., Width: 1-7 y 1-+ Depth: /_�,0 , + <br /> Survey Submitted: Yes ✓ No Date of Survey: <br /> Proposed Setbacks: <br /> Front (Lake ) : (0,S t Right Side: <br /> Rear (Street) : 0164 Left Side: AI(A <br /> Adjacent Structures : A&Aja Wetland: <br /> Building Height: Def. Hgt. N(A, Peak Hgt. <br /> Avg. Setback: MA Lot Coverage: <br /> Existing Proposed <br /> Hardcover: 0-75 ' <br /> 75-250 ' <br /> 250-5001 20<0 <br /> 500-1000 ' <br /> Hardcover Variance Required: Yes No ✓ Date of Council Approval: <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File:# Resolution # : - Resolution Date: <br /> REMARKS (in house) : _ <br />