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. ' . CgECR OFF LIST FOR ISSIIANCE OF P�RMITS <br /> - � FOR OFFICE USE ONLY <br /> ADDRESS OR LEGt'�L: /,$-�O /��2�f �' PID: <br /> 0/^� �//� ISL�S'r��'`'3-J �dC� ��!G <br /> DSSCRIPTION OF WORK- �� ____ � _____ ' <br /> --------------------- - - DATE APPROVED: �I12��1� <br /> ZONING REVIEW BY: <br /> �l/f. DATS APPROVED s <br /> BIIII�DING REVIEW BY: W --------------- <br /> ------------------ <br /> --------------------- <br /> FEES TO BE CHARGED� Misc. Fees Calculate By: <br /> PERMIT Yes <br /> �No ��L�-►�� �-��"``_ <br /> PLAN REVIEW Yes ��` a SEWER CO ECTION <br /> STATE SURCAA�GE �es Y/No WATER CONNECTION <br /> pARK FEE <br /> IWESTIGATION FEE Yes NO gITE INSPECTION <br /> SAC Yes No <br /> specif 1 <br /> Number of SAC Units OTHER ( Y <br /> ------------- <br /> ------------ <br /> ZONING CHECR LIST <br /> Zoning District: <br /> Post Office• School District: <br /> Fire Department: , <br /> Lot Area : <br /> Width: Depth: � <br /> No Date of Sur ey: <br /> Survey Submitted: Y S � <br /> Proposed Setbac}s� : <br /> Front (Lak �/Right Side: <br /> � / <br /> Rear (Str t) : Left Sid : <br /> � es : Wetland: <br /> Adjacent tructu <br /> � Peak Hgt. <br /> BuiJ.ding Heig t: Def . Hgt. ' <br /> r <br /> ' ot Coverage: <br /> Avg. Setback proposed <br /> xi stin,� <br /> r j_ <br /> Hardcover: 0-75 ' �' <br /> � <br /> i <br /> 5 250 ' <br /> -I i <br /> i <br /> �Sq-500 ' <br /> , � <br /> �00-1000 ' �� <br /> Ye / No Date of Council ApprovaJ�: <br /> Hardco er Variance equ red: � <br /> � g Co�.ncil Approval Date : <br /> Gradin : Staf f Appr vaJ. Date: Y= <br /> Septi : Staff Appro al Date: By� <br /> Zoning File- # Resol ion # : �Resolution Date: <br /> gEMp,ggS (in house) : � <br />