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CHECK OFF LIST FOR ISSUAIVCE OF PER�ti,fITS <br /> FOR OFFICE USE ONL Y <br /> ADDRESSORLEGAL: �125 c�x�"oR � �A+O <br /> PID: <br /> DESCRIPTION OF Yi�O.RK: � ��a - �- <br /> ---------------------------------------------------------------------- <br /> ZOtVI�VGREVIEtVBY: DATEAPPROVED: z- 8 -oS � <br /> BUILDINGREVIEWBY: DATEAPPRO�'ED: z-e-a.f <br /> --------------------------------- <br /> FEES TO BE CHARGED: tL�lisc. Fees Calccclated By�: <br /> PERttifIT Yes �/ No <br /> PLAN RET/IEYV Yes �/ tVo SEtiT�ER GOtV'�VEGTION <br /> STfLTE SURCHARGE Yes � ��/o tiVfiTER CONtVECTlON <br /> ItVVESTIGATION FEE Yes [Vo ./' P�LRK FEE <br /> SAG ,Yes No � SITE INSPECTIO�V <br /> Nurnber of SAC U�tits 02'HER (specify) " <br /> ------------------------------------------------------------------------------------------------ - <br /> Z'O�YI�YG CHECh'LIST Zoni�:g Dish•ict: <br /> Fire Deparhner�t: Post Office: Sc/tool Distrlct: _., <br /> Lot,�lrea: Sq.ft. Act•es 6Vidtlt Depth <br /> Sccavey Scebrriitted: Yes�_ No Dczte of Scuvey: /o •�9 •p� <br /> Proposed Setbacks: <br /> We�t(Lake): Z�5 Rigl:t Side: � Z <br /> P<e�r(Street): I�Z Left Side: �7 <br /> �idjncent Str•uctures: ' 6Yetland: �' <br /> Building Height: Def. Hgt. 0,k Penk Kgt. — <br /> Lot Coverc�ge: � ,•+�r4 <br /> Grading: Staff,4pp►'oval Date: - Bv: Coz�ncil Approvcsl DRte: <br /> Septic: StnffAppr•oti�al Date: � BY� <br /> Zoning File: # �p.f 5 Resolution: # Resolution Dnte: <br /> Shorelancl Distr•ict: n'�� <br /> Avg.Setback: Blicff Setback: it//A Lot Coverage: <br /> Existing Proposecl <br /> Hardcover: 0-7�' O b <br /> 75-250' 9• 3 � <br /> 150-500' 2i. 1 � z+.� <br /> 500-1000' <br /> Hm�dcaver Variance Reqc�irecf: Yes No�c_ ' :Date of Council�lpproval: <br /> ItEMA.RKS(ire hoecse): p " T ��v�R /�c o Ec.' �,J r� <br /> � 0`ia L a, c:-�r �,; <br /> 31 <br />