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CHECR OFF LIS'� FC,�t, ISSUANCE OF PERMITS <br /> . FOR OFFICE USE ONLY <br /> ADDIt$SS OR LEGAL: �FS�U �'`i0 I'��`� PID: <br /> D$SCRI PTION OF WORR: i1 c_.��^-•:�-Q-�- ����� <br /> -------------------------------------------------------------------------------- <br /> ZONING REVIEW BY: N r� DATE APPROVED: � - <br /> BIIILDING REVIEW BY: � ��� DATE APPROVED: <br /> FEES TO BE CHARGED: Misc. Fees Ca�culated By: <br /> PERMIT Yes �'� No <br /> PLAN REVIEW Yes �No SEWER CONNECTION <br /> STATE SURCHARGE 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 LIST Zoning District: <br /> Fire Department: Post Office: School istrict: <br /> Lot Area: �_ Width: Depth: <br /> � <br /> \ I ' <br /> Survey Submittedl Yes No Date of Sur ey: <br /> �� <br /> Proposed Setbacks:� � <br /> Front (Lake) : Right Side: i <br /> , <br /> Rear (Street) Left Side:�� _ ��, <br /> � � <br /> Adjacent Stru tul�es: W�tland: 1 <br /> i � <br /> Building Height: ef.\\Hgt. ; Peak Hgt. '� <br /> i <br /> Avg. Setback: � Lot C verage: � <br /> i <br /> Exis, ing Pro�osed � <br /> � <br /> Hardcover: 0-75 ' � , <br /> i <br /> 75-250 ' i <br /> � <br /> 250-500 ' i � <br /> 500-1000 ' <br /> Hardcover Variance�, Required: Yes No ; Date of Council App�ova�: <br /> Grading: Staff App�oval Date: By: ', Council Approva� Date: <br /> , �- � <br /> Septic: Staff Appriova� Date: $y: <br /> Zoning File: # Resolu�vion #: ', , Resolution Date: <br /> REMARKS (in house) : <br />