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, . CHECK OFF LIST FOR ISSIIANCE OF PERMITS <br /> FOR OFrICE USE ONLY <br /> �DxEss OR LEGAL: � 3 �0 �o F�2� �2 �� PID_ o � - i �'� - z3 - Y� - av �'� <br /> �ESCRIPTION OF WORR: N�w � 5 <br /> -------------------------- ----------- <br /> I.ONING REVIEW BY: DATE APPROVED: J 1- 2�{-�j Z <br /> BIIII.DING REVIEW BY- DATE APPROVED: / /� Z�-f `�i Z . <br /> ----------------- <br /> F$ES TO B$ CBARGED: Misc. Fees Ca�culated By: <br /> PERMIT Yes � No � <br /> PLAN REVIEW Yes �/ No SEWER CONNECTION .� ZZ.S• �o Pee ►'►'�. P � <br /> STATE SURCHARGE YeS �/ NO WATER CONNECTION <br /> I;�IVESTIGATION FEE Yes No l/ PARR FEE <br /> �AC � Yes ✓ No SITE INSPECTION <br /> 'Icimber of SAC IInits 1 OTHER (specify) <br /> --------------------------------------------- <br /> ZONING CHECR LIST Zoning District: ( lZ.-ll3 <br /> �� re Department: y�,p�rvc� Post Office: �Vl,p�n�c� School District: <br /> .ot Area: �S, 2S6 sy �T" � Width: I�f 9. 75 Depth: 2YD '% AVe <br /> urvey Submitted: Yes�_ No Date of Survey: y' �' � Z <br /> 'roposed Setbacks : , <br /> Front (Lake) : �j b r �' Right Side: 3S 6 �' <br /> Rear (Street) • !vd ��' Left Side: .j 5 f- <br /> Adjacent Structures : N�A Wetland: it/'�19 <br /> ?uiJ.ding Height: Def . Hgt. Z3 � Peak Hgt. Ff � <br /> �_vg. Setback: ^//A Lot Coverage: <br /> Existing Proposed <br /> :iardcover: 0-75 ' <br /> 75-250 ' <br /> 250-500 ' <br /> 500-1000 ' 4• 2� � <br /> Hardcover Variance Required: Yes No ate of u cil Approval: <br /> / <br /> Grading:. Staff Approval Date: By: unc' I. Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File:# R l.0 on �: R solution Date: <br /> RFI�SARKS (in honse) : <br />