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�CI3ECK flFF i�IST FOR ISSTIANCE OF PERi.�IT5 <br /> FOR OFFICE USE ONLY <br /> ApDRESS 4R LEuAL: 9 05 ��FWrJAt.E �"�A� W <br /> PID: <br /> DESCR.IFTI��T OF WORK: (Jc:.Lk �t- c-�r-1� <br /> --_�______�..--------- <br /> ----- --- ---- DATE APP�OVED: i - � ?-�+o a� <br /> ZOY�IG REVIE'4V BY: P G D�,TE APPROVED: /- i�-a'�, . <br /> SUIZDLNG RE`t��V BY: � . <br /> -------- ------------ _ � <br /> k`EES TO BE CHA.RGED: Misc. Fees Caiculated By: <br /> PERMIT Yes � No <br /> PLAN REVIEtiV � Yes -� No SE�VE.R CO�ECTION <br /> STATE SURCHARGE Yes �� No �VATERCONNECTIO�; <br /> INVESTIGATION FEE Yes No � P�IRK FEE <br /> SAC Yes No —�� SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ----------------- <br /> ZOYI�� C�CK LIST Zaning Discric�: LR- l/� � <br /> Fire Department: <br /> Post Office: School District: � <br /> De [h <br /> l,,or P,zea: Sq.ft. �Z v�g� Acres 2•'�� Width P <br /> Survey Submitted: Yes _� No Date oE Survey: 7-�`l' �� <br /> Proposed Setbacks'; � � <br /> Froac(Lake): �,3 Ri�t Side: <br /> RC3C(Jticetj; LaEt �ide: <br /> Adjacent Structures: AT1/'ICNv� Wetland: /Y �� <br /> Buil�lin�Hei��: Def, Hgt, �.!//� Pe�.k Hgc. — <br /> Lot Coverz�e: /��� <br /> No CMr�ivG Co�cLL �pprcv�., Date: -- <br /> Gradin�: S�aff App:ov�l Date; t �;: <br /> � <br /> Szpcic: 5�2fi App�Q'/� Dace: /�►//� �: <br /> Zoaing F�lz: R Ob�31� � Reso�u:ioe: n Resolu:ion Da:e: 2 '"Z7`4.6 <br /> Shorel�^.d District: �S- _ <br /> �v?. Setba�'u: ��Allc�q u L� B��Ff Setback: �J ��' LoC Cove2�e: /�J J� <br /> J EuSc:�g Proposed <br /> HzdCoveC; 0-75' ,Jp. ?i2„ (O.� (� <br /> 75-2;0' 3 . 21 � .2/ <br /> 2�0-SQO' <br /> �00-:G+,��� <br /> � r, C���-,��i c.?�-�vz: 2-Z7• 6 6 <br /> :.?"�,CC'��. 1+��.�C� `'.'_y'_.:�C: :z5 . � ---•- -� <br /> F.L,�L�'}�S (i.�hou�e): <br />