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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> w ADDRESS OR LEGAL: I (LI O T UJ PID: <br /> DESCRIPTION OF WORK: -. A r0 Q / T) 6 PJ 4t Z ry cQ 0-1'0,D/Z- 0 y Q./l lrX l S -110 6UOE <br /> ------------------------- ------------------------------------------------ <br /> ZONING REVIEW BY: DATE APPROVED: <br /> BUILDING REVIEW BY: wr- DATE APPROVED: <br /> --------------------- ------------------------------------------------------- <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes k11--No <br /> PLAN REVIEW Yes-7"- No SEWER CONNECTION <br /> STATE SURCHARGE Yes No WATER CONNECTION <br /> INVESTIGATION FEE Yes Noy PARK FEE <br /> SAC Yes No SITE INSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECK LIST Zoning District: <br /> Fire Department: Post Office: /00 C School District: /OC <br /> Lot Area: /'V(L Width: Depth: <br /> Survey Submitted: Yeses_ No Date of Survey: pill /=6C.e <br /> Proposed Setbacks: , <br /> FFrorrt (Lake) : A) .(� Right Side: ;?-C) -� <br /> Rea&' (Street) : //6- Left Side: N1,4- <br /> Adjacent Structures: A 77W¢� C-0 Wetland: <br /> Building Height: Def. Hgt. Peak Hgt. <br /> Avg. Setback: of Co erage: <br /> /'ance <br /> ' sting Pro osed <br /> Hardcover: <br /> 75 <br /> 250 <br /> 500-Hardcover Vired Yes o Date of Council Approval: <br /> Grading: St1 Da e: By: Council Approval Date: <br /> Septic: Stplf Approva D e: By: <br /> Zoning Fi / :# Res ol tion Resolution Date: <br /> REMARKS ( n house) : <br /> I <br />