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� CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> ' FOR O�ICE USE ONLY <br /> ADDRESS OR LEGAL: '�f L/( ' '�x s�- <br /> PID: <br /> DESCRIPTION OF WORK: , <br /> , <br /> ZONING REVIEW BY.��2����� ���_� DATEAPPROVED: I � � � �� <br /> BUILDINGREi�IEWBY.• �_ DATEAPPROT�ED: ( • 1 - v°1 � <br /> FEES TO BE CHARGED: Misc. Fees Calculated B��• M � ~��� � �� <br /> PERMIT Yes ,� No <br /> PLAN REVIEW Yes r/ No SEYI�ER CONNECTION <br /> STATE SURCHARGE Yes ✓ No u�ATER CONNECTION <br /> INVESTIGATION FEE Yes No ,� PARK FEE <br /> SAC Yes No ✓ SITEINSPECTION <br /> NumbeT�ofSAC Units ,., � OTHER (spec��) <br /> �___________-----_____�__��______�_____ <br /> ZONING CHECK LIST Zoning Distr�ict: ��� Y~�� ��� � �' —____�__ <br /> Fire Depai�tment: Post�ce: School Disd�ict: <br /> Lot Ar�ea: Sq.ft. �"f �� 'J� Acres �• �� Width Depth <br /> � •��11�1(� (�ZL �1.� <br /> Survey Submitted: �'es__�[�_ No Date of Survey: <br /> Propose cks: � ,;j� ! / � � ,l°�` <br /> ro (Lake): ��i�(l Ra�it Side: �� � ��.,!`y 4;, w� ����`�, , y� <br /> 7�c��.� �� �'�'' ��y��f; C� �,.�� <br /> �� � � 1�,�' � ��-., � � � �,t, � ;�,'� �, P�.,�c� <br /> �Rear Street : / e Side: � W� �� ���,,���" <br /> ,�� Y � �r� <br /> acent Structures: Wetland: � �/'� S�`�" <br /> Buildin Hei ht: De . H t. � � "d�"���� � <br /> S S .f g Peak Hgt. <br /> Iv � <br /> Lot Covera e: �n^ <br /> g �' !�����'�2�1/� <br /> Grading: StaffApproval Date:G�� � C.il.'C Bi�:�����`Council Approval Date: � <br /> Septic: StaffApproval Date: � �` � � d'�� B : ��_�� � <br /> Y <br /> Zoning File: # Resolution: # Resolution Date: <br /> /� , 1. <br /> Slaor�eland District: !�"��t MCWD Permit: <br /> Avg. Setback.• B1uffSetback: LotCoverage. <br /> Fxisting Piroposed <br /> Hardcover: 0-i�' <br /> 75-2.i0' <br /> ?.i 0-.i 00' <br /> 500-1000' <br /> Ha�•dcover f�ariance Required: Yes No L Date of Council Approval: � �� <br /> ��,�— <br /> REMARKS(in house): <br /> 33 <br />