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CHECK OFF LIST ;.OR T,SSUAI�'CE OF PERtiIITS <br /> FOR OFFICE USE ONLY <br /> :�DDRESS OR LEG�I.: /� �5� ��' �'r PID: l�� -ii � — �3 `/� n�'�� <br /> DESCRIPTIO\ OF ��'ORIi: h'c-,y�� �' C �� <br /> -------- -------- <br /> ZO��G RE�'IE�V BY: N DATE APPROVED: <br /> BUII.DL�G REVIE`V BY: DAT'E APPROVED: � - 5 -�i S <br /> - --------------------------- <br /> FEES TO BE C�-L�RGED: Misc. Fees Calculated By: <br /> PERv1IT Yes !/ �0 <br /> PL��N REVIEW Yes No r/ SEWER C0IVNECTION <br /> STATE SURCHARGE Yes ✓ No WATER COI�NECTION <br /> INVESTIG�TIO�i FEE Yes No PARK FEE <br /> SAC Yes No SITE INSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ----------------------------------- <br /> ZOi�L\G CHECK LIST Zoning District: Shore Districc : <br /> Fire Depanmen Post Offi e: School strict <br /> Lot Area: Sq.� . Acres Width Depth <br /> Survev Submi tzd: Yes , o Date of Surve : <br /> Proposed Set acks: <br /> F:o t lLake : Right Side: <br /> Re (S[ree[) Left Side: <br /> A acen[ Stru tures: W tland: <br /> Building ei�hc: Def. gt. P H°t• — <br /> Avg. Secb ck: Bluf Setback: Lot Coverage: <br /> Exi ting Proposed <br /> Hardcov r: 0-75' <br /> 75-250' <br /> 250-�00' <br /> �00-1000' <br /> Hardco er Variance Require : Yes No ate of Council Approval: <br /> Gradin : Staif Approval Date By: Council Approval Date: <br /> Septic: Staff Approval Date: B � <br /> Zonin File: n Resolution: # Resolution Date: <br /> ��. (in house): <br /> 26 <br />