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s CHEC� OFF LIST FOR ISSIIANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: Z� Z� �S� ( T PID: <br /> DESCRIPTION OF WORK: ADA � TiGi`' ________________ <br /> ------------- ------------ <br /> ----------------_-----2& ti � <br /> ZONING REVIEW BYs� DATE APPROVED' � <br /> B�ILDING REVIEW BY: V�.� t��.�-- DATE APPROVED: �' 2� ' `l -� <br /> --------------- <br /> FEES TO BE CHARGED- Misc. rees Cal.culated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Yes v' N� SEWER CONNECTION <br /> STATE SURCHARGE Yes L-� " 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 /> --------------g------------- 2 - / L <br /> ZONING CHECR LIST Zonin District C <br /> Fire Department: ���t„ u�-_� Post Of f i ce: �v��,-zT�_ SchooJ. Di strict: w E 5-t-o N r��n <br /> Lot Area: ���� 2 � <br /> Width: I S�J � Depth: /SS�� 'Fl `` � <br /> Survey Submitted: Yes X No Date of Survey: '� - � � - ^? �> <br /> Pro osed Setbacks: ,_ ,. � .�, ' � <br /> P Front (Lake) : �U � C'r=' Right Side: ��3 - �'-� <br /> � > ' �-��.� Left Side: ' _. � <br /> Rear (Street) : n_�> <br /> Adjacent Structures: � %"�� <br /> r� <_%� Wetland: `v �� <br /> r� <br /> Building Height: Def . Hgt. � �� Peak Hgt. C .' ` <br /> �,1 '/� Lot Coverage: `� � <br /> Avg. Setback: pro osed <br /> Existing P <br /> Hardcover: 0-75 ' <br /> 75-250 ' <br /> � � �a <br /> 250-500 ' �� �� ��� � �0 �� � <br /> 500-1000 ' <br /> Hardcover Variance Required : YeS N� �'�— <br /> Date of Council Approval: <br /> g Council Approval Date: <br /> Grading: Staf f Approva�. Date: Y= <br /> i <br /> Septic: Staff Approva � Date: � By� <br /> i <br /> Zoning Fil.e:# <br /> ResoJ�uti�n #: Resolution Date: <br /> � <br /> REMARKS (in house) : <br /> i <br /> � <br /> � <br />