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� ` - CHECR OFF LIST Fli�.SIIANCE OF PERMITS <br /> � FOR OFFICE USE ONLY �_ � <br /> ADDRESS OR LEGAL: �J %% `"/G�l��f(�. ��4�,�< /'��-� PID: ��� % ��/ 7 . � � 5�� G �� <br /> �ESCRIPTION OF WORR: �� ���� <br /> --------------------- ---- --------------------------- <br /> ZONING REVIEW BY: DATE APPROVED: g ` ZS -�� <br /> BIIILDING RLVIEW BY: DATE APPROVED: g ' Z`3'`3 S <br /> ----------------------- <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓�No <br /> PLAN REVIEW Yes �/ No SEWER CONNECTION <br /> STATE SURCHARGE Yes !/ 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 CHECR LIST Zoning District: <br /> Fire Department: Post ffi c�S District: <br /> � <br /> Lot Area: Width. pth: <br /> Survey Submitted: Yes No y� Date of Survey: � r'-'�w� S�2�y °2 <br /> /�c�n�.�►J <br /> Proposed Setbacks: � �+ <br /> Front (Lake) : �b � Right Side: � <br /> Rear (Street) : S2> � "`� <br /> Lef t Side: Sv � -f'- <br /> Adjacent Structures: �4�71�4Q�1�� Wetland: �l/(/�- <br /> Bui7.ding Height: ef . Hgt. Peak Hgt. <br /> Avg. Setback: Lo Coverage: <br /> Existing roposed J <br /> / <br /> � <br /> Hardcover: 0-75 ' � <br /> i <br /> 75-250 ' ,' <br /> , � <br /> � � <br /> 250-500 ' / <br /> i <br /> 500-1000 ' � <br /> Hardcover Varian e Requi�red: Y s o Da 'e of Council A rovaJ.: <br /> Grading: Staff A proval. D te: By: CounciJ� Appro al. Date: <br /> Septic: Staff A proval Dat : By= <br /> Zoning File:� Re olu ion � : Resolution Da e: <br /> � <br /> RRMARRS (in hou e) : <br /> \ <br /> \ — <br />