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r ' 1 CHECR OFF LIST FOR ISSDANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 3-I`'�S �I`�'0(��Z�/�'e Q(L PID: <br /> DESCRIPTION OF WORK: I�o� �v'Q'�� J'��'� _ <br /> -------------------------- <br /> -------------------- <br /> ZONING REVIEW BY: DATE APPROVED: 'S�-' S "�S <br /> BIIILDING REVIEW BY: �X�- DATE APPROVED: 5� 1 5 '`T,5 <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 /> ZONING CHECR LIST Zoning District: <br /> Fire Department: ' Pos Off � c • �iool District: <br /> Lot Area: Wid h: Depth: <br /> Survey Submitted: Yes b2---No Date of Survey: 6� L�- <br /> Proposed Setbacks: , I l � � <br /> � Front (�� • �N j� Right Side: I ((� <br /> Re a r (Stx-e�e't7 s ��� � ,` Le f t S i d e: �.L� �-`� <br /> Adjacent Structures: �''�'���� Wetland: /c� /y�' <br /> Pea Hgt ' <br /> Bui7�ding Height: Def . Hgt. . f <br /> Avg. Setback: L t Cover ge � <br /> Exist' Propos <br /> �' <br /> Hardcover: 0-75 ' <br /> 75-250 ' ' <br /> 250-500 ' <br /> 500-1000 ' <br /> Hardcover Variance j�equire : es No � Date of Coun il Approval : <br /> Grading: Staff Apg <br /> roval D te: jBy. Counci Approval Date: <br /> � <br /> Septic: Staff Approval Da e: BY= <br /> Zoning File• # e olution # Reso ution Date: <br /> REMARRS (in ho�se) : <br />