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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 3 d O/et. S-iaivfg , a, N PID: '��� r�3 � - DOO <br /> DESCRIPTION OF WORK: Con C12,4S/0 n 61-4h + 41 a40 1-C <br /> ZONING REVIEW BY: �. � . (0 A DATE APPROVED: '=f-/2'44) <br /> BUILDING REVIEW BY: ' '• I DATE APPROVED: 1 -/-5-- <br /> 4C <br /> I -/- _Z <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes V No <br /> PLAN REVIEW Yes ' No SEWER CONNECTION <br /> STATE SURCHARGE Yes �- No WATER CONNECTION <br /> INVESTIGATION FEE Yes No t PARK FEE <br /> SAC Yes No� SITE INSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECK LIST Zoning District: 6c/ <br /> Fire Department: Ko Post Office: Goz5 e4Ic School District: O/tn,AJO <br /> Lot Area: NU Width: colt 777,6 Depth: <br /> Survey Submitted: Yes pC No Date of Survey: X ' 30"53 <br /> Proposed Setbacks: <br /> Front (Lake) : 0 /lam i- Right Side: <br /> Rear (Street) : Z-30r4 Left Side: LA--) 3od <br /> Adjacent Structures: /J104 Wetland: /07,4 <br /> Building Height: Def. Hgt. l7 r S° Peak Hgt. / <br /> I <br /> Avg. Setb. Lot Coverage: <br /> jk <br /> Existing Proposed <br /> Hardcover 0- • ' <br /> 5-250 ' <br /> ,,50-500 ' <br /> 510-1000 ' <br /> Hardcove . Variance R_quired: Yes No D..te of Counci Approval: <br /> Grading: Staff Approv- Date:_, By: • Council Ap.roval Date: <br /> Septic: - taff Approval sate: B : <br /> Zoning F le:# Resolution Resolution •ate: <br /> REMARKS in house) : <br /> r <br />