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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 3 Z-O 'T-u 2N PID: <br /> DESCRIPTION OF WORK: ne._ &AoA off <br /> 1J-----------------------------------_--------------- <br /> -------------------- - <br /> ZONING REVIEW BY: DATE APPROVED: 9- <br /> BIIILDING REVIEW BY: DATE APPROVED: to, -C14 <br /> ------------------- <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT <br /> Yes No <br /> PLAN REVIEW Yes �No SEWER CONNECTION <br /> STATE SURCHARGE Yes &�--No WATER CONNECTION <br /> INVESTIGATION FEE Yes NoSG PARK FEE <br /> SAC Yes No SITE INSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECK LIST Zoning District 9A-1A <br /> Fire Department:__fm�plr P44mf <br /> Post Office: M,,-' School District: 0461VO <br /> Lot Area: ! 3}5S Z'�d Width:-- 3S/ Depth: z S2. <br /> Survey Submitted: Yes/ No Date of Survey: <br /> Proposed Setbacks: <br /> Front (Lake) : ( �3•? Right Side: <br /> Rear (Street) : Zpv' f Left Side: 190 14- <br /> Adjacent <br /> 4-Adjacent Structures: 5�� 'r Wetland: N <br /> Building Height: Def. Hgt. 23 Peak Hgt. 23 S <br /> Avg. Setback: A L t Co erage: <br /> E isting Pro osed <br /> Hardcover: 0-75 ' <br /> 75-250 ' <br /> 250-500 ' <br /> 500-1000 / — 1, <br /> Hardcover Vari nce Requir d: Ye::;o Date of Council Approval: <br /> Grading: Staf Approval D te: BYT— Council Approval Date: <br /> Septic: Staf Approval Dat By: <br /> Zoning File # R solutio #: Res lution Date: <br /> REMARKS U house) : <br /> � I <br />