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� <br /> . � <br /> � CHECK OFF LLST FOR ISSU��iCE OF PER'YIITS <br /> FOR OF CE USE `���'�� <br /> �iDDRESS OR LEGAI,: � G �-yL' <br /> PID: C��l�//�� � 3 33 aGe>3 <br /> DESCRIPTION OF WORK: �- <br /> ZOiVING REVIE`� BY: n�(i� DATE APPROVED: <br /> BUII,DING RE'VIE�V BY� (�,,.��.- DAT`E APPROVED: 3•�-56 <br /> - -------------------------- <br /> FEES TO BE CHARGED: �1isc. Fees Calculated By: <br /> PERIViIT Yes ✓ No <br /> PLAi�1 REVIEW Yes � No SEWER CONNECTION <br /> STATE SURCHARGE Yes � No WATER COI�NECITON <br /> INVESTIGATION FEE Yes No � PARK FEE <br /> SAC Yes No �/ STI'E INSPECTION <br /> Number of SAC Units OTHER (specify) `M _�_ <br /> ----------------------------- <br /> ZO�VG CHECK LIST Zoning District: Shorelan District : <br /> � <br /> Fire Department: Post Office: - School Distric : <br /> � W� � � Depth <br /> Lot Area: Sq.ft. Acres %� � <br /> i <br /> Survey,Submitted: Ye � Nt� ate of Survey: `` <br /> ,' � / �', <br /> Proposed Setbacks: � �� � <br /> Fron[ (Lake): ,� 12ight Side: � <br /> r <br /> Rear (Street): _�___�____ ` �fr Side: ' � �i <br /> , a <br /> Adjacent Structlires: � We�land: <br /> / <br /> .�- • <br /> ; �_--��------_ _ ___. <br /> . Building Height: Def; Hgt• P� H�' <br /> i <br /> i <br /> � � �luff Setback: �_ i I-ot Coverage: <br /> Av�. Setback: � �— <br /> � i <br /> �Eeistin� � Proposed �'� <br /> i I � l <br /> Hardcover: d-75' ' � ` <br /> � r �' <br /> i�75-250' ( � , 1 <br /> j 250-500' ,' i � ��1 <br /> � �00-1000' �` � � ' <br /> r � <br /> Hardcover Uariance Requir :� Yes �o Date of Council Approval: � <br /> � �� By: Council Approval Dat�: <br /> Grading: taff Approval D t : <br /> Sepdc: taff Approval Dat By' <br /> Zoning File: # Resolution: � Resolution Date: <br /> p���[�RI�,S (in house): <br />