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� ' � CHECR OFF LIST FOR ISSIIANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRRS S OR LEGAL: �Z%9 l�,'l)0 L�G� f�t+v PID: �� -�/ � -:�7 3 .-� �- �'�- ��/ <br /> DESCRIPTION OF WORR: (LEv►'�o��=�- <br /> ----------------------------------------------------------------- <br /> ZONING REVIEW BY: /]/�I� DATE APPROVED: <br /> BIIILDING REVIEW BY:_S� ,,,� DATE APPROVED: 1/ "/ �I2� <br /> --------------------- -------------------------------------Z----------------- <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes �No ' <br /> PLAN REVIEW Yes ✓� No SEWER CONNECTION <br /> STATE SURCHARGE Yes � 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 CHECR LIST Zoning Distr ct: <br /> Fire Department: Post Office: Schoo� Distr' c : <br /> Lot Area: Width: Depth: <br /> Survey Submitted: Ye No Date f Sur ey: <br /> Proposed Setbac s: <br /> Front (Lak ) : Rig t Side: <br /> Rear (Str et) : Le t Side. <br /> Adjacent Structur s : Wetland: �� <br /> i <br /> Building Hei ht: Def. gt. Peak Hgt. ' <br /> Avg. Setbac : L t Coverage: <br /> Exi ting �Proposed <br /> Hardcover: 0-75 ' <br /> ! <br /> . <br /> 5-250 ' <br /> 50-500 ' � <br /> � <br /> I <br /> 00-l000 ' f % <br /> Hardcover Variance Requ' ed: Yes� No Dat , of Council Approvalc <br /> � <br /> Gradin�: Staff Approva /Date: By: / _ Council Approva� Da�e: <br /> ; <br /> � , <br /> Septi : Staff Approval Date:_ ' BY=�_ <br /> Zoni g File:# / Resoluti n # : /� Resolution Date: <br /> / `I <br /> REM�RKS (in house) : ' � <br /> . <br />