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' CHECK OFF LIST FOtR ISSIJAi�10E OF PER1vIITS <br /> FOR OFFICE USE ONLY <br /> �DDRESS OR LEG�I.: lvo A-�-- PID: <br /> DESCRIPTIO\ OF «'ORK: '�-e-�� <br /> ----------------------------- <br /> - ---- <br /> ZOYL�'G RE`'��V BY: DATE APPROVED: � - i�t- y.s <br /> BUII.DL\TG REVIE`V BY: DATE APPROVED: 6 - r �- �5' <br /> -----------------__----- <br /> FEES TO BE CH.�iRGED: Misc. Fees Calculated By: <br /> PERI�IIT Yes �� No <br /> PLAN REVIEVV Yes �'' 1 SEWER CONNECTION <br /> STATE SURCHARGE Yes No WATER CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITE INSPEC"ITON <br /> Number of SAC Units OTHER (specify) <br /> ----------------------------- -------------------------- ' ___________ <br /> ZONI�i iG CHECK LIST Z nin istrict: Sh eland District : <br /> , � <br /> Fire Department: ost ffice: 'ct: , <br /> LotArea: Sq.fr. cres id epth <br /> Survey Submitted: Yes � No Date of Survey: C�� ��� <br /> Proposed Setbacks: <br /> Front (Lake): Right Side: �nJ� �,�C,�c w�T� <br /> Le8 Side: ��� a���� �� <br /> Rear (Street): --�G•�,.+ 3 o't <br /> ��G tles s <br /> Adjacenc Structures: �J7',rT4t��c--'''� Wetland: N�✓� �"'�� G� <br /> Building Heighr. Def. Hgt. /✓�1`� Peak Hgt. <br /> Avg. Setback: Bluff Setback: t Coverage• <br /> Existing Propose <br /> Hardcover: 0-75' <br /> 75-25 ' <br /> 250- 00' <br /> 500 1000' <br /> Hardcover Varian Requ� ed: Yes No Date of ouncil Approval: <br /> Gradin,: Staff pproval ate: y: Council Appro Date: <br /> Septic: Staff pproval ate: BY� <br /> Zoning Fil : Resolution: ft Resolution Date <br /> REN (in h ). <br /> 26 <br />