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� CEECK OFF LIST FOR ISSIIANCE OF PF.RMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: ,3�U QI�o �5�� � PID: <br /> D$SCRIPTION OF WORK: �����= 5�v� <br /> ------------------------------ <br /> ------ ----�----------------- <br /> ZONING REVIE�1 BY' ��.� DATE APPROVED: /- 2 S�S S <br /> �(� � DATE APPROVED: � - 2-5 -�S <br /> BIIILDING REVIEW BY: l�(�-- _. <br /> --------- -------- <br /> FEES TO BE CH�RGED- Misc. Fees Calculated By: <br /> PERMIT Yes � No <br /> PLAN REVIEW Yes �o � SEWER CONiVECTION <br /> STATE SURCHARGE Yes r/ 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 /> ZONING CHE�K LIST Zoning District: (L-S <br /> Nan�P <br /> Fire Department: (��Na�wTr2�1�V-P�st Office : � Schoo� District: MTpc� <br /> Lot Area: /1��L Width: — Depth: — <br /> Survey Submitted: Yes No pc Date of Survey: s�►-� Pc.�,J <br /> Pro osed Setbacks : <br /> P Fs-�x� (Lake) : f/o i� � +' Right Side: S�` ± <br /> ge�� ( Street) : 7Z.� � Left Side: So� '� <br /> Adjacent Structures : ,�g' Wetland: /J/!'� <br /> BuiJ�ding Height: Def . Hgt. � •k- Peak Hgt. — <br /> Avg. Setback: 0 •� Lot Coverage: D•« <br /> Existing Proposed <br /> Hardcover: 0-75 ' <br /> 75-250 ' ���� �� <br /> 250-500 ' <br /> 500-1000 ' <br /> Hardcover Variance Recuired : Yes No �( Date of Council Approval : <br /> Grading: Staff Approval Date: � By:; � Counci� Approval Date: <br /> , / <br /> Septic: Staff Approval Date: � BY= <br /> Zoning File• � R o�u�ion # � Resolution Date :__ <br /> ' � �, <br /> RL'MARRS (in house) : � � <br />