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CIIBCX OFF LIST FOR ISSUANCE OF PERHITS <br />FOR OFFICE USE ONLY <br />.1 <br />ADDRESS OR LEGl\L DESCRIPTiON: .1(_. i . /. ·' .' 'i /' / /· /,'. ,L /',,,/, <br />PID: --------------------,------- <br />/// <br />DESCRIPTION OF WORK:~/_._,_'~1~(_,_,_:_1_···_1~·--'---r_1_'_'·_·_1_,_1_, ________________ _ <br />-------------·------------¥------------------------------------------------------ <br />ZONING REVIEW BY: {)',/2:_\ DATE APPROVED: // / ~:;;j2;,_, <br />BUILDING REVIEW BY:_~~~~~''---'------'-'\~'•-•------ <br />PERMIT ISSUED BY: ----------- <br />.DATE l\PPROVED : __ l'---i _________ _ <br />DATE: -------------------------------------------------------------------------------~-----------------· <br />FEES TO BE CHARGED: Misc. Fees Calculated By: :•,,::-._!_\ <br />/ PERMIT Yes )• No SE'i·lER UNIT $ -- <br />PLAN REVIEW Yes ✓ No SEWER CONNECTION -- <br />STATE SURCHARGE Yes/ Ne., WATER CONNECTION <br />PENALTY Yes No PARK FSE -- <br />SAC Yes No SITE INSPECTION <br />OTHER (specify) <br />ZONING CHECK LIST Zoning District: L {' · / C ---~------ <br />Fire Department:_!_'_._L __ _ Post Office: I ----School District: --------(if';.·,/.,,· <br />{ <br />I • <br />Lot Are a : ---'~•,...,_'_, _/_1_\_, __ _ _l Widtl1: __ ~_•_1 ____ _ <br />; qc ... Depth : __ !_1 _____ _ <br />Survey Submitted: Yes v/ No ··t r, <br />Date of Survey:_~_-"-,--·--'------ <br />Proposed Setbacks: .._•I,'/( <br />P'l:'ont (Lake): "C; , \1'1f Right Side: ;:c,.·rJ, ,,_. fL, ----~----- <br />R<crar (Street): i ::.'( · ., Left Side: 7)( ' ' !(' ·' <br />Adjacent s::ructures: /' ·rt , --\ .' <br />Existing <br />Hardcover: 0-75' <br />75-250' <br />Wetland: <br />Proi:osed <br />. ~ ,,.;-_____ <br />' -l <br />------------- <br />Hardcover Varic1nce Required: Yes .X No Date of Co~ncil Approval: ___ ~_:_f_~r-':_; <br />Grading: Staff Approval Date:~-/ '·o 1'.' ,_ \ <br />By:,'J,/--'-Council Approval Date: ___ _ <br />Septic: Staff Approval Date: _____ _ By: __ _ <br />Zoning Fi le: It /.' ;>C' Resolution #:-'_,_,_/_':_,_~--Resolution Date:'/ y·, f-',f) <br />REMARKS ( in house): _________________________________ _