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CT'IEC]K, pF�' i.IST FOR ISSUANCE 4F' 3'E�'�TS <br /> FOR OFFICE USE ONLY� <br /> p,�}D]�ESS OR LEGAL: 3 a'-1 �� �A.�c'u :��'C'i�' <br /> PTD: ��,✓�.4-r��� <br /> �7E5C�tIP'�'X�N OF WORK: rlS�c�.� l?-�5 o�v �.�x�s���a <br /> --_-----.----- ------;^^__��+F------------------pATE APPR.OVED; ------i�,��-�C.�=-�-- <br /> ZOYI`IG- R.EVIE�V BY: �� i � L �� " ` ��"� DAT`E APPROVED: � - �� -o�� . <br /> '�UTI,DING REVIEtiV BY: . . . <br /> FEES TO BE C��GEA: Misc. Fees Calculated By: <br /> P���T Yes ,/ No <br /> PLAN �tEVIE`V � Yes � No SE�VER COi�INECTION <br /> ,/ No tiVATE�RCONNECTION <br /> STATE SURCHAR.GE `�eS No � pAR�E{ gEE <br /> II�iVESTIGATION FEE �'eS �o � S�'EINSPECTTON <br /> SAC Yes <br /> ( pecify) <br /> Number of SAC�Units P►��� 6-�c�- b� � �S�� OTHER s ___ _____ __r___ __ __ <br /> -------------------------------- � i <br /> �ONr��IG CH�CK LIST' Zoaing District: !- }`` ' � <br /> Pos[Office: Schaol District: � � <br /> Fire Dep3rtment: . 1 <br /> Lot Area: Sq.ft. ��i�'� Acres i� a �� Width �� Depth <br /> . �)' <br /> Survey Submicted: Yes �_ No <br /> Date of Survey: �I 7 I v� <br /> Proposed Setbacks: , U � �t Side: ' �� ,�/ . <br /> Froa[(Lake); `, � <br /> �_ ,; . � �,� � <br /> �, , , <br /> treet ' � ` ft Side: <br /> Rear�/ )�" , n� <br /> rrL�j3CP�� Strtr7�rc:; <br /> bVer►?*�d: �v� <br /> � � / / <br /> auil�ling Hei�t: DeF. Hgt. ____ Peal`h?�' <br /> I(1 �-G` <br /> Lot Covera�e: ' �+� <br /> Grading: S�aff Approval Date: fV0 CN�'NC�2 BY: -U� Cou°cL Approval Date: ' <br /> Septic: Staff Approva! Date: �y' �A 1 V <br /> � �_ "! � <br /> �27�0 Resolutioa: n`.�G'G`�> Resolution Da:e: � �� <br /> 7oaln� Fi]e: � �_ �_ -- <br /> Shore;and Distric�: �/�- 4 L� � �' ' ���6 <br /> , �� Setback: � L.ot Cove2�e: - <br /> Avg. Se[bacc:: 1 �'�" Pro osed <br /> Etst�g �t�( L( �'1 D <br /> H�ec�ver: G-7�' ��� <br /> 7�-25Q' / <br /> . <br /> 2�'�-��i��' D <br /> ��0-1G�C�J' <br /> � - ,- ..- � � -�- �. <br /> �� � ,. �� __._ �: Lc��.,_� .-,�_ <br /> u,-c�o.;e. -,;�z,��� _ _��.-;,,,. :e� <br /> �.��L•-`�a-�� �_L�h o��el: (-}-o� s.e �Q <br /> VIGPc�- � C/��SC� � r I 2L <br />