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,_. - ��,�C���-����( �- �-� --c',/ - <br /> ' CHECR OFF LI5T FO� IS�IIANCE OF P$RMITS <br /> FOR OFFICE USE ONLY <br /> ADDR$SS OR LEGAL: ��I�S 5 1 xT"H AV� N U PID: Z�••"' II g ' �� �„`�',�, ;��.��':' ',` <br /> DESGRIPTION OF WOR�: Y�1 CC-I� <br /> ZONING RLrVIEW BY: .�'//�YI'�\. -----------DATE APPROVED: 12- Z-Z�-- /�----------- <br /> BIIILDING REVIEW BY: DATE APPROVED: .`n'�.- �"�-�-- `�I� <br /> --------------------- ----------------------------------y�-- --� ----------� <br /> FEES TO BE CHARGED: Misc. Fees Calculated B --� <br /> PERMIT Yes � No <br /> PLAN REVIEW Yes� No SEWER CONNECTION `""" <br /> STATE SURCHARGE Yes� No WATER CONNECTION �- <br /> INVESTIGATION FEE7 Yes No-� PARK FEE � <br /> SAC Yes No� SITE INSPECTION <br /> �iumber or SAC Units OTHER (specify) - <br /> ZONING CHECR LZST -----------------Zoning District �-/�•�� -------------------. <br /> Fire Department: � � l� � Post Office: � � � School District: U��'r�t-��`� <br /> .�o t <br /> �-�.. ! , .,�.. <br /> Lot Area: �-� Aet �` Width: .� �.� "'` Depth: 1 <br /> Survey Submitted: Yes X No Date of Survey: J5 °ta <br /> P� osed Setbacks : t �, �- � + � <br /> ��Front .�e-}�:' �� Right Side: � - � <br /> e <br /> r ,; Rear (�}� • �� � � Left Side: .�� �= �� <br /> � � <br /> Ad jacent Structures : f `;�� �''�t_.�#'L�� Wetland: � C..� �' '�`� <br /> Building Height: Def. Figt. --�-� Peak Hgt. '°'�'P�� <br /> 3vg. Setback: ""'""'" Lot Coverage: `�"" <br /> Existing Proposed <br /> riardcover: �J-75 ' <br /> 75-250 ' <br /> �.. d;" �,,.. ;a,! <br /> 250-500 ' � � ;'�� �'. _- ' <br /> .�'--� � ��� °�" f, <br /> 500-1000 ' ,,a � ""` _ <br /> ;3ardcover Variance Required: Yes ^ No ,� Date of Council Approval: `"—" <br /> �rading: Staff Approval Date: --� By: `�" Council Approval Date: ' <br /> ,`:� ,^_�_ : <br /> �eptic: Staff Approval Date: NO c^c�r.�s � i��j By: ;;�. <br /> �oning File:� .� - Resolution #: "`' Resolution Date: "� � <br /> . � i <br /> . ; <br /> �BMARKS (in house) : <br /> + <br /> I <br />