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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> ' - FOR OFFICE USE ONLY <br /> c ' <br /> ADDRESS OR LEGAL: Z V�7 W�y7.dt?Yt C�c-J� PID: <br /> DESCRIPTION OF WORK: <br /> -------------------- - - ----- <br /> -------------------------- - <br /> ZONING REVIEW BY: DATE APPROVED: <br /> BUILDING REVIEW BY: AIM DATE APPROVED: <br /> ---------------------------------------------- <br /> FEES TO BE CHARGED: Misc. nFees Calculated By: <br /> PERMIT Yes )L � o <br /> PLAN REVIEW Yeses_ No SEWER CONNECTION <br /> STATE SURCHARGE Yes No WATER CONNECTION <br /> INVESTIGATION FEE Yes No 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: Post Office: School District: <br /> Lot Area: Width: Depth: <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks : <br /> Front (Lake) : Right Side: <br /> Rear (Street) : Left Side: <br /> Adjacent Structures : Wet and: 1 <br /> Building Height: Def . H eF <br /> Avg. Setback: Lot Co erE s ing Pro ose <br /> Hardcover: 0-75 ' <br /> 75-250 ' 7 L <br /> 250-500 ' <br /> 500-1000 ' <br /> Hardcover Vari nce RVIate:_ <br /> d: Yes No Date of C uncil Approval: <br /> Grading: Staf Approte: By: Cou cil Approval Date: <br /> Septic: Staf Approv By: <br /> Zoning Fil : # esol io # : R solution Date: <br /> REMARKS ( ' house) : <br />