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, , CHECK OFF LIST FOR ISSDANCE OF PERMITS <br /> v FOR OFFICE USE ONLY <br /> ADDRSSS OR LEGAL: S�d NO 14��"'� Q/Q pID' <br /> DESCRIPTION OF WORR: �C-'GC� fi ZNTt,�10�. ��N151-� !�'v �ASQ�� <br /> ------------------- ------------------------------ <br /> ZONING REVIEW BY: DATS APPROV�: S- Z�'S `I <br /> BIIII,DING RSVIBW BY: DATS APPROVSD: S LS'�`'j �( <br /> -------------------- -- <br /> FEBS TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes f No <br /> PLAN REVIEW Yes �"' No SEWER CONNECTION <br /> STATE SURCHARGE Yes v No WATER CONNECTION <br /> INVESTIGATION FEE Yes No � PARR FEE <br /> SAC Yes No �� SITE INSPECTION <br /> Number of SAC Units OTHER (specify) <br /> -------------------------------------------------------- <br /> ZONING CHEGR LIST Zoning District: <br />\ <br /> Fire Department: Post Office: Schoo]. District: <br />� Lot Area: Width: Depth: <br />� rvey Submitted: Yes �C No Date of Survey: <br /> '�Ar�► r=i�� <br /> Proposed Setbacks: �/� <br /> �t (Lake) : /� Right Side: <br /> �. (Street) : Lef t Side: 1(�c�� <br /> Adjacent Structures: �-7'T'�G��� Wetland: �'� <br /> Bui�ding Height: Def. Hgt. ,��� Peak Hgt. <br /> Avg. Setback: � •�C Lot Coverage: <br /> Existing Proposed <br /> Hardcover: 0-75 ' <br /> 75-250' <br /> �c �_ <br /> 250-500 ' <br /> 500-1000 ' <br /> Hardcover Variance Required: Yes No� Date of Council Approva�: <br /> Grading: Staff Approval D te: By: C uncil Approval Date: <br /> Septic: Staff Approval Da e: By: <br /> Zoning File:# R olution esol.ution Date: <br /> REIKARRS (in house) : <br />