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1nCo�v�u� w c✓K c� - nv z��n g r ss�s <br /> CHECK OFF LIST FOR ISSUANCE OF PERIYIITS <br /> . ' F R OFFICE USE ONLY <br /> ADDRESS OR LEGAL: � `�s ?�c7 �'�` !��^^ �— �"f{ <br /> PID: <br /> DESCRIPTION OF Yt�ORK: 1 <br /> ---------------------------------------------�---------------------- ------------------------------------ -- --- <br /> ZONING REYIE tV B Y: � DATEAPPRO VED: g 3 a <br /> BUILD,ItYG REV,I'EW BY: DATEAPPROVED: � �3-�b <br /> FEES ?'O BE CHARGED: Nlisc. Fees Calctclatecl By: <br /> PERII�IIT Yes ✓ No <br /> PLAN REVIEGV Yes—� No SEWER GON[VECTION <br /> STATE SURCHARGE Yes_/ �Vo ' yVATER CO�WECTION <br /> ItVVESTIGATIONFEE Yes No ✓ PARKFEE <br /> SAC Yes ' 1Vo� SITE NSPECTIO�V <br /> Nz�nxber of SAC Units OTHER (specify) <br /> ------------------ <br /> Z0IVIIYG CHECh'LIST Zanin;Disd•ict: NO C1�174Nl1-2 <br /> �1 <br /> Fire Depa�•hnent: Post Office: Sc/xool Dish•ict: . _. <br /> Lot..�Lrea: Sq.ft. �Icres �Vidth Deptl: <br /> Su�vey Submitte�� Yes Na Date of Swvey: <br /> Proposed Setbac/s: <br /> Fror:t(Lake): Right Side: <br /> Rear(Sh•eet): Geft Side: <br /> Acfjacent Sn•ucteu•es: b tland: <br /> Buildi�rg Height.• Def. Xgt. Pe 'Hgt. <br /> Lot Coverc�ge: <br /> Gracfing: Staff'�fpprovcil Date: _ By: _ _ ^oacncil Approval Dccte: <br /> Septic: Staff,�pprovc�l Date: ("] � 3' �� BY� `'�c� <br /> Zoning File: # Resofutio�z: !# Resolcation Date: <br /> Sha•eland Dish•ict: <br /> Avg. Setbc�ck: B1uff SetbRck: Lot Coverage: <br /> Eiisting Proposed <br /> Hardcover•: 0-7�' <br /> 75-?50' <br /> 250-500' <br /> 500-!000' <br /> Hardcover 1/ariance Reqccired: Yes No Date of Coiutcil�[pproval: <br /> RELI�IARKS(in house): <br /> 31 <br />