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' C3EC� OFF LIST FOR ISSIIANCE OF P�MITS <br /> � FOR OF�'IC�: L'SE ONLY <br /> ADDRESS OR LEGdL: I?� NO �A2N1 PID: <br /> DESCRIPTION OF WORR: F�N►5�-! �1'�SEYv��."►`+T" <br /> ------------------------------------------------------------ --- <br /> ZONING REVIEW BY: N�� DATE APPROVED: <br /> BIIII.DING R�?VIEW BY: CP�✓10 �Lv�►.--- DATE APPROVED- �-1'�!-!3 <br /> ----------------------- -------------------------- - <br /> FEES TO BE CHARG�D: Misc. rees Ca.Iculated Bv: <br /> PERMIT Yes ✓� No <br /> PLAN REVIEW Yes f No S�.WER 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 LIST Zoning Distr;ct: <br /> Fire De�artment: Pos` Ofr"ice: Sc�oo1 Dist;ict: <br /> Lot Area: Width: Depth: <br /> Survey Submitted: Y s No Date or Sur e�T: <br /> Proposed Setbacks : <br /> � Front (Lake } ignt Sid <br /> Rear ( St�ee ) Ler"t Si � <br /> Adjacent S ructure / Wet?a <br /> Building Heig . Def. gt. P� k Hgt. <br /> Avg. Setback Lot Cov rage: <br /> EX S�� 5 P?'OD S eQ <br /> Hardcover: 0-75 ` � <br /> � 75-250 ' /� <br /> 250-500 ' % <br /> i <br /> 500-1000 ' <br /> Har cover Variance qnired: Yes No Date of Cou ciI Approval: <br /> Gr ding: Staff Appr val Date By: Counci Approval. Date: <br /> Septic: Staff Approval Date: BY= <br /> Zoning File:tt Resolution n: Resolution Date:_ <br /> F�RMARK$ (in house) : <br />