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, CHECR OFF LIST FOR ISSIIANCE OF PERMITS <br /> • � � � FOR OFFICE USE ONLY <br /> ADDRFSS OR LEGAL: /S 3�S C:v/v C> C.�,¢�-C.' r'��.�'r'::� PID: <br /> DESCRIPTION OF WORR: k��„'�� <br /> -------------- --- -- ------------- <br /> ------------------- ---- ---' -------- ----� �� � � <br /> ZONING REVIEW BY: f � �� DATE APPROVED: - <br /> BIIILDING REVIEW BY: �- � �{,v-t--� DATE APPROVED: 5 "�� <br /> ----------------------� ---------------------------------- --- --------------- <br /> FEES TO BE CHARGED: `� Misc. Fees Calculated By: <br /> PERMIT Yes �..� No <br /> PLAN REVIEW Yes .� No SEWER CONNECTION <br /> STATE SURCAARGE 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 Li�T Zonzng District: �.r'-j� <br /> Fire Department- l',o,�.c. .c=; Post Office: (�-,�,���=' School. District: u�4'`�O <br /> Lot Area: ���ivc�y:,�� •2i kc��5 Width: S'�.�S � � Depth: ��' � � <br /> Survey Submitted: Yes � No Date of Survey: 2 Z-`75 _ <br /> Proposed Setbacks : . j � <br /> �� (Lake) : Right Side: �' <br /> Rear (Street) : � � � Left Side: ` U ( <br /> . a <br /> Adjacent Structures: Wetland: <br /> Bui].ding Height: Def . Hgt. Peak Hgt. <br /> Avg. Setback: Lot Coverage: <br /> Existing Proposed <br /> � <br /> Hardcover: 0-75 ' <br /> ,� � � t� <br /> 75-250 ' � �=- r ' � <br /> 250-500 ' <br /> 500-1000 ' <br /> Hardcover Variance Required: Yes� No Date of Council Approval: <br /> Grading: Staff Approva7. Date: By: Council Approval. Date: <br /> Septic: Staff Approval Date: BY= <br /> Zoning File: # �L'�� � Resolution # : 5��� Resolution Date: r�'� �� �S <br /> REMARRS (in house) : <br />