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� •- � ' "� CHECK OFF LIST FOR ISSIIANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS �� LEGAL: � �0 PQr 1`– �--�.�1''�'� PID: <br /> . . <br /> DSSGRIPTION OF WORR: L;tJ�'����C.-T <br /> S� 'e <br /> ------------------ �J' - ------------------�------------��-�-----�C�------ <br /> ZONING REVIEW BY: dt�. DATE APPROVED: (o- Z(�•�/� <br /> BIIILDING REVIEW BY: C7 DATE APPROVED: G " ZG ��1 6 <br /> ----------------------- -- <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes � No <br /> PLAN REVIEW 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 /> -----------L--- <br /> ZONING CHECR LIST Zoning District: 2-1� <br /> Fire Department: N� G� ost Office: — Schoo� District: � <br /> Lot Area: 1�; Dd 1 S�, Width: �vo G�-f'�°�►'�f Depth: <br /> Survey Submitted: Yes� No Date of Survey: � -/ �' � G o^� �"��= <br /> Proposed Setbacks : / <br /> Front (L-a�k�e) : 33�Z Right Side: /'�r /� <br /> Rear (c�_r�-��- ) ; �f(/} Left Side: IL� <br /> � �- <br /> Adjacent Structures: /f'�'�y}(�(�� Wetland: al/�i� <br /> Buil.ding Height: Def . Hgt. � • (C Peak Hgt. �" <br /> P vg. S etback: /� t l'� Lot Coverage: 2� •7 <br /> Existing Proposed <br /> Hardcaver: 0-75 ' <br /> 75-250 � `�Y�Y`'7� <br /> 250-500 ' <br /> 500-1000 ' <br /> Hardcover Variance Required: Yes OL No Date of Council ApprovaJ.: 6 ZY- <br /> Grading: Staff Approval Date: � By: Council Approval Date: <br /> Septi c: S taf f Approval. Date: �--' By: <br /> Zoning File:# 2�3�i Resolution # : 3 �=� �� Resolution Date: (- Z Y 1� <br /> REMARRS (in house) : <br />