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CHECK OFF LIST FOR ISSUANCE OF PERINIITS <br /> • FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: :KIS T o N tc taw A <br /> PID: <br /> DESCRIPTION OF WORK: C,&aAT'Q. (3�c ti cJC� T ty�uc <br /> ZONLNG REVIEW BY: DATE APPROVED: <br /> BUILDIINO REVIEW BY: ty(A- DATE APPROVED; <br /> FEES TO BE CHARGED: (vAAo(w-j Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Yes No SEWER CONNECTION <br /> STATE SURCHARGE Yes No WATERCONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC-Units OTHER(specify) <br /> ZO`-r G CHECK LIST Zoning District: N'o C( Le <br /> do <br /> Fire Department: Post Office: School District: <br /> Lot Area: Sq.ft. Acres idth th <br /> Survey Submitted: Yes o Date of Survey: <br /> Proposed Setbacks: <br /> Front( ) Right Side: <br /> Rear(Str et): Left Side: <br /> Adjace Struc res: W tland: <br /> Building Heigh : Def. H t. P ak Hgt. <br /> Lot Coverage <br /> Grading: S ff Approval ate: By: until Approval Date: <br /> Septic: S f Approval Dat : By: <br /> Zoning F e: # Resolution: # Res 1 'on Date: <br /> Shorel d District: <br /> Avg. Setback: Bl ff Setback: Lot Coverage: <br /> E 'sting Proposed <br /> Hardcover: 0 75 <br /> 7 - 0' <br /> 2 500' <br /> S -1000' <br /> Hardcover Variance Required: Ye No Date of Council Approval: <br /> REMARKS Cin house): <br /> 7 <br />