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_ � CHECR OFF LIST FOR ISSIIANCE OF PERMITS <br /> ` FOR OFFICE USE ONLY <br /> ADDRESS OR LECAL: Z(oU5 I/V�R�c-E- 2t��r'r" (��t' PID: <br /> DESCRIPTION OF WORR: � • C��2A - = ---------- <br /> ---------DATE --- <br /> ------------------------------ <br /> —� APPROVED: � - Z�- �►� <br /> ZONING REVIEW BY: <br /> ` DATB APPROVED: q' - 2�-S � <br /> BIIILDING REVIEW BY: '�� --- -------------------- <br /> -------------- <br /> -----, ------------------ <br /> FEES TO BE CH.ARGED- Misc. Fees Calculate y� <br /> PERMIT Yes ,/� No <br /> PLAN REVIEW Yes �' No SEWER CONNECTION <br /> WATER CONNECTION <br /> STATE SURCHARGE YeS � N� pAgK FEE <br /> INVESTIGATION FEE Yes No r�'� <br /> SAC Yes No � SITE INSPECTION <br /> OTHER ( specify) <br /> Number of SAC Units -----------� <br /> ---------------------------- <br /> ZONING CHECR LIST Zoning District: �./� -/6 <br /> Post fi Se-Yrool District: _ <br /> Fire Department: � /,-- . <br /> Lot Area: , Width: <br /> ! ` P� <br /> Survey Submitted: Yes_ C� No <br /> Date of Survey: o N -4-� � Z� �� �a"�' <br /> Proposed Setbacks: <br /> Front (Lake) • z-zO� �= Right Side: �1 p r "� <br /> Rear (Street) : ?"Z � t Lef t Side: N�/}' <br /> Adjacent Structures : �S � t wetland: N�/� <br /> Hei ht: Def. H t. �U ` Peak Hgt. //. S <br /> Bui�ding g g <br /> Avg. Setback: �� l< Lot Coverage: Nl� <br /> Existing Proposed <br /> Hardcover: 0-75 ' <br /> 75-250 ' 23.� 2S�v <br /> 250-500 ' <br /> 500-1000 ' <br /> Hardcover Variance Req <br /> uired: Yes No�_ Date of Council Approva�:__ <br /> Grading- Staff Approval Date� /'� /�� BY= �Council Approval Date: � <br /> Septi c: Staf f ApprovaJ. Date: `^ BY= �' <br /> File•# — Resolution tt : -_` Resolution Date:�_ <br /> Zoning - � <br /> � _ . __ 2�� ;-U�� ���c 1?"� r�'C, U /�'�'_1� <br /> REMp,RgS (in house) . JU�-��.,�,_.._-, ;�.�-`��-., � . <br />