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� . <br /> . 4 ` CHSCR OFF LIST FOR I�SIIANCE OF P$RMITS <br /> FOR OFFICE USE ONLY <br /> � ,. <br /> .. <br /> .� , � <br /> r <br /> /� _. <br /> ADDR$SS OR LEGAL: � �� � • . � .• �� , - ;:., . PID ` ' � r � ^ �.•� A ' <br /> L .�.. ..�. , _ �,, <br /> /� i � <br /> DESCRIPTION OF WORR: ��1� �'�F� l` < < 'a'���'=�fi �'�" ��.� <br /> -------------------�-�------------------------------------�--------------------� <br /> ZONING REVIEW BY: l//��1� DATE APPROVED: � � ' <br /> BOILDING REVIEW BY: C� DATE APPROVED: � '� 3 "�1a <br /> FSES TO BE CHARGED: Misc. Fees Calculated By �i/�'`^�1J- <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Yes�� No SEWER CONNECTION -� <br /> STATE SURCHARGE Yes� No WATER CONNECTION ~ <br /> INVESTIGATION FEE Yes No / PARK FEE -- <br /> SAC Yes No f SITE INSPECTION --�- <br /> Number of SAC Units OTHER (specify) `" <br /> ------------------------------------------------------------------------------� <br /> ZONING CHECR LIST Zoning District : �. � ` � � <br /> L_ , �... , � ,•;. , <br /> Fire Department: Post Office: r"/.� r' School District: v'�r---�� �`� .� <br /> ,� / <br /> Lot Area: �"'�� . "� Width: -�C� Depth: 2. 2- � <br /> Survey Submitted: Yes� No Date of Survey: 1e�'�� <br /> Proposed Setbacks : , � . � � ► •:� <br /> �e.n.�Lake ) '�� ' Right Side: , <br /> I � � � <br /> -�-a� ( Street ) „�- � Left Side: ; <br /> � � � is� / , <br /> Adjacent Structures : r` ��`'' -� � Wetland: ';�r,.� <br /> �°" ' � ' <br /> Building Height: Def. Hgt. �_'� Peak xgt. ' <br /> •, r /� <br /> Avg. Setback: ! Lot Coverage : �� � "� �'r�° ( ��` � � . . " `t ; <br /> Existing Proposed �� �, , �c,� . , , , <br /> Hardcover: 0-75 ' � � i����-�- ��`'''d��_- `�b <br /> �. ,4 .' ' e►'L�j, b� L o'T` C o v'G� <br /> 75-250 ' .' �, <br /> zso-soo � �- . �.,L,2 Y�so L -� z �/z.'� <br /> 500-1000 ' ` <br /> Hardcover Variance Required: Yes �° No Date of Council Approval: � � �' '> <br /> Grading: Staff Approval Date: ��� By: - Council Approval Date: <br /> Septic: Staff Approval Date: - BY� ` � <br /> Zoning File: # <br /> Z �� Resolution �: 2 ��� � Resolution Date: � � " <br /> . . i <br /> RSMARRS (in house) : j <br /> I <br /> ( <br /> I <br />