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� v CHECR OFF LIST FOR ISSIIANCE OF PERMITS <br /> � FOR OFFICE USE ONLY <br /> ADDRESS OR I�EGAL: y�SO �-�ND(=/V �'�/� PID: <br /> DSSCRIPTION OF WORR: t�1l�C� <br /> ------�--- ��------------------------------------ <br /> ZONING REVIEW BY: DATS APPROVSD: '�S'LS-�i Z <br /> BIIILDING REVIEW BY: (i' a� DATE APPROVED: 8''Z S�'�7 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 ✓ PARR FEE <br /> SAC Yes No � SITE INSPECTION <br /> Number of SAC IInits OTHER (specify) <br /> ZONING CHECR I.IST -----------------Zoning District-- L---/�------- <br /> Fire Department: �1/�G Post Office: /j//� School District: �/�C <br /> Lot Area: /✓l�-- Width: �/�� Depth: /(��G <br /> Survey Submitted: Yes� No Date of Survey: `� -/ 3 � 7�7 0� ��4�r� <br /> Proposed Setbacks: � <br /> Front (Lake) : 35 �-�' Right Side: `�`� �*' <br /> Rear (Street) : /V�� Left Side: /V�A <br /> Adjacent Structures: �¢T!'79U'f E� Wetland: N/�4 <br /> Building Height: Def. Hgt. /U/A Peak gt. <br /> Avg. Setback: o Covera <br /> Ex' ting roposed <br /> Hardcover: 0-75 ' <br /> 75-250 ' <br /> 250-500 ' <br /> 500-1000 ' <br /> Hardcover Varia e Requ red: e No Date of Council Approval: <br /> Grading: Staff pproval Date- By: Council ApprovaJ. Date: <br /> Septic: Staff pproval ate BY= <br /> Zoning File- so ution #: Resolution Date: <br /> REMARRS (in onse) : . <br />