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�" ' CHECR OFF LYST FOR ISSIIANCE OF P$RIKITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: ' � �,� ,� � 'l �-f f � <br /> �) ��i �1 �� > � �'r-� �t.�r vz_ PID: C'f��� � .I - ��1 C;� � <br /> DESCRIPTION OF WORK: �; t� �( , �.e-c-f �U� �7c�s�r�tic, ��c �?,��y_t�rt # (�3�iFS <br /> ------------------------- <br /> ------- --------------- ----------------------------- <br /> ZONING REVIEW BY: (�i,t�o �Q�t/y�ew— DATE APPROVED: 6 -/S'yZ- <br /> BIIILDING REVZEW BY: DATE APPROVED: 6'�S��i2 <br /> FEES TO BE CHARGSD: Misc. Fees Calculated By: <br /> PERMIT Yes � No <br /> PLAN REVZEW 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 I.IST Zoning District: �-I/rI <br /> Fire Department: W�o�+�,✓� Post Office: �...p�rvr� School District: nl�L <br /> Lot Area: Width: Depth: <br /> Survey Submitted: Yes DC No Date of Survey: <br /> /' � �,� � � � <br /> Proposed Setbacks: �C� C��1'� I/ `� � � �-2 (�� �� <br /> Front (Lake) : Right Side: <br /> Rear (Street) : Left Side: <br /> Adjacent Structures : Wetland: <br /> Building Height: Def. Hgt. Peak Hgt. <br /> Avg. Setback: Lot Coverage: <br /> Existing Proposed <br /> Hardcover: 0-75 ' ' <br /> 75-250 ' / <br /> i <br /> 250-500 ' <br /> 500-1000 ' � <br /> Hardcover Variance R qui ed: Yes No Dat of Cou cil Approval: <br /> Grading: Staff App val at : By: Counci Approval Date: <br /> Septic: Staff App oval D t : By: <br /> Zoning File: # R solution � Res lution Date: <br /> REMARKS (in hou e) : <br /> � <br /> ��. N'A 5 �� X�A���✓U �N� �O J� �'�'��C.�cJ✓l.E ri4r� N�c...� Q-P CO/vSi'72,!G7�4! <br />