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CHECK OFF LIST FOK ISSUAtVCE OF PEIZtti.tITS <br /> FOR OFFICE USE ONL Y <br /> ADDRESS OR LEGAL: 3s O Q(Lo��v ,�� s° <br /> PID: ' <br /> DESCRIPTIO�V OF YVORK: v,J I N�/Jn W S <br /> -------------------------------------------------------------- <br /> ZOtVINGREVIEyvBY: N(/� D.ATEAPPROVED: <br /> BUILDING REVIEW BY• - _ DATEAPPR06'ED: �-i -o S <br /> ----------------------------------�------------------------ - - - - - - ------------------------------- <br /> FEES TO BE CHARGED: �Iisc. Fees Calc�claced 8��: <br /> PERI�IIT Yes ✓ No <br /> PLA�V R.EVIEGV Yes �_ �Vo J SEWER CONNECTION <br /> ST�TE'SURCH.4RGE Yes � tVo tiVATER CONNECTIOIV <br /> ItVVESTIGATION FEE Yes tVo P�(RK FE'E <br /> St1C Y'es 1Vo SITE tNSPECTIO�V <br /> Nc�mber• of SAC U�iits OTHER (specify) <br /> ------------------------------------------------------------------------------------ <br /> ZO�VIIVG CHECh'LIST Zar�i,tj Discr•icc: /��' G/fi4'rv <br /> Fi�•e Depa1•hrter�t: Post Office: School Dist�'ict: __.. <br /> Lot.drea: Sq.f't. Acr•es 6�idtl� Deptlz <br /> Scuvey Su6r�iitted: Yes No Date af Scuvey: <br /> Proposed Setbacl;s: <br /> Frorit(Lake): Right Side: <br /> Rear(Str•eet): Geft Side: <br /> �Idjacent Structures: Gf�etlnnd: <br /> Bu�fding Height: Def. Hot. Peak Kgt. <br /> Lot Cover•nge: � <br /> G/'CiClU1g: StC�ff.4pprovc�l Date: By: Coculci!rlpp�roval Date: <br /> Septic: Staff,�lpprot�a!Date: BY� <br /> ZonirTg File: # Resolutiat: Resolt�tion Dn[e: <br /> Sltoreland Distr•icf: <br /> Avg. Setback: Blccff Se ack: Lot Coverage: <br /> E�isiin,; Proposed <br /> HR�•dcover: 0-7�' <br /> 75-2.i 0' <br /> 250-500' <br /> 500-1000' ' <br /> Ha��cicover• Ya�•iat�ce Reqticir•ed: Yes No Date of Couracil�Ipproval: <br /> RE1I�IARKS(i�t Itotcse): <br /> 31 � <br /> 4 <br /> T ,, <br /> *;r„ <br /> � � �: . � <br />