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. CHECR OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: ��� C �' ��".-�e� /t�'/L PID: � 7 - /��- .� =3 �..� l�C C� � <br /> � <br /> D$SCRIPTION OF WORK: ��i ,�, � ��;-c�-,->^ <br /> ---------------------T------------------------------------------------------- <br /> ZONING REVIEW BY: c�c,,,(vCQ�-a�.. DATE APPROVED: �(-l2- S`� <br /> BIIILDING REVISW BY: DAT$ APPROVED: �I -� 2-' cl � <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes � No <br /> PLAN REVIEW Yes ✓ No SEWER CONNECTION <br /> STATE SURCHARGE Yes oi' 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 District: /Qr2-!(j <br /> Fire Department: �p�+y C�4KG Post Office: CAie:c. Schoo� District: p�o�uD <br /> Lot Area: Z .I l Width: 27c�` '� �4u� Depth: 3 2,� � '�' �,4.vQ <br /> Survey Submitted: Yes� No Date of Survey: �"�" eJy <br /> Proposed Setbacks : � <br /> Front (Lake) : S"v• Z Right Side: ��o� � <br /> i , <br /> Rear (Street) : Zc�.,S, �' Left Side: �"$. �? � <br /> Adjacent Structures : /1/I/�- wetland: NG�B- <br /> Building Height: Def . Hgt. / � , _ Peak Hgt. 2 y � <br /> Avg. Setback: Lot Co e age: <br /> E i ting Pro s d <br /> Hardcover: 0-75 ' <br /> 75-250 ' <br /> 250-500 ' <br /> 500-1000 ' <br /> Hardcover Variance Req ired: Yes N Dat of Council Approval: <br /> Grading: Staff Approval Date: 'y- - 5'� By:�,(�i Counci� Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning Fi�e: # ; , ��� Resolution Date: <br /> ��:�tiY- <br /> REMARKS (lII house) : �yi�� �:�,��2 <br /> fi` <br /> b�� ��� . <br /> �-I Z��`� <br />