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' -CHE�� p�`F i,IST FOR ISSUANCE O�' PE��IT5 <br /> • FOR OFFICE USE ONLY <br /> ApDRESS OR LEixAL: 3165 �� �N�°� �- <br /> PID: <br /> �ESCR.IPTI4�T OF WORK: �� G' - ------------------- <br /> -------------------------- - <br /> ___------------ -- ---------- ,z -z�- o�. <br /> _��---- pATE APP�OVED: <br /> ZOY.I�IG REVIE�V BY: � <br /> gUTLDII\G REVIE�V BY: <br /> . ..0 DATE APPROVED: ,2-L� -�6� <br /> ---=--------- —�----- -------------------------__---------------------- --------- <br /> F`EES TO BE CHARGED: Misc. Fees Calculated By: <br /> �E�T Yes ✓ No <br /> PLAN REVIEti�1 � Yes —� No SEti�E.R CO�INECTION <br /> �VATER CONNECTT.Oi� <br /> STATE SURCHARGE �'eS � N0 p�g� FEE <br /> INVESTIGATION FEE Yes No � <br /> Yes No � SITEINSPECTION <br /> SAC # � OTHER (specify) <br /> __Number of SAC�Units A,o ��-zv-�s y2� - � /a�� � <br /> � � _1 c�..i!L�.__�'��-'�_�='�' � ----�-.1_u.�7� <br /> --------------------------------- <br /> -----------�-- 1� /p <br /> C� , <br /> ZOiVIi�IG CHE.CK LIST Zaning District: L 2-/� • <br /> Fire Department: <br /> Pos[Office: School District: • <br /> �r p,rea: Sq.ft. (�(�,0 21 Acres � � 3`� � Width Depth <br /> gurvey Submicted: Yes �( <br /> �o Date oE Survey: � Z�• 0`� <br /> Proposed Setbacks'; <br /> Front(Lake): ( S6 � Ri�t Side: I 2. Z , <br /> Rear(Streetj: <br /> �c> � Left 5ide: Z-� <br /> Adjacent Structures: /'v�.4 �Vetland: /��� <br /> Buil�lin�Height: Def. Hgt, � � � Peak.Hgc. — <br /> Lot Coverage: o��'�- ���^ <br /> �z_� -o� <br /> I 2•27-"ljfi`,: LGwiCu r�l�,�:CV3.� n3t?: �--- <br /> Gradin�: S�aFf Approv�l Date: ow. - <br /> Septic: Staf� Appra��a� DacP: N (� E;�: <br /> Zooing Fue: R o�'7v�3S Resolutioe: n__ Resolution Date: I 2-I►- �b <br /> Sheretzr.d District: y�5 BluEf 5etback: N (� I.o[Coveta;e; �•�� _ <br /> AvQ. Setback: C�•K <br /> � E�istino Proposed <br /> v <br /> Hzdcover: 0-75' 2S <br /> 75-2�0' <br /> 2�0-500' z� •7 <br /> �00-:GC�' <br /> �_ �,._ �� �'���-,��� c.,�.ovz: <br /> ::a-�CC',.,- �,'_"�,C� �.�y'u.:_�. .,._ . • : <br /> F.E�L�RKS (in hou�el; <br />