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�Q-�� i a-i 9- �� <br /> . _ _. - -- ---- -- - - <br /> �.= _. - , <br /> CHECR OFF LIST FOR ISSIIANCE OF PSFt1�iITS <br /> FOR OFFICE USE ONLY <br /> �nxEss oR �c�: ,��,_3 `-,� ��� �` /�i� /� �iD: 2� -- /1 g- 2 � � l C�D��-` <br /> DESCRIPTION OF WOR�:��.'ti�� .� 7,7r,� ` I��('�-'y - I L�X I�v �iA�"^ �C t�•. <br /> ! <br /> ZONING REVIEW BY:--,����-------------DATE APPROVED:-�2. -�`�-1�------------ <br /> BQILDING REVIEW BY:� nnn,r,,,_ DATE APPROVED: I Z-1-7 -4 a <br /> e <br /> -------------------- --------------------------------------�1---------------� <br /> FEES TO BE CHARG$D: Misc. Fees Calculated By: �'� � <br /> PERMIT Yes�VC' 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 I,IST Zoning District: �12 - � � <br /> Fire Department: L L-- Post Office: � �- School District: ����"^"�� °�' <br /> ,� � , � � r� t <br /> Lot Area: � C c" � Width: -- _� - Depth: y;% � � <br /> Survey Submitted: Yes� No Date of Survey:� Z- �o `g� �'-`�-`�``���'�''� "� j <br /> Proposed Setbacks : Q ' � � � 1 <br /> Front (�a�) : � ( 0 � Right Side: � • <br /> , , <br /> Rear (-�==='�) : �� � - Left Side: } � "� ` <br /> Adjacent Structures : �'� /'��-�E-�'('� wetland: �'iJoN�`` <br /> , � � <br /> Building height: Def. Hgt. �Z - Peak Hgt. �LI <br /> Avg. Setback: � Lot Coverage: �J�, <br /> -E isting Proposed <br /> Hardcover: 0-75 ' <br /> 75-250 ' <br /> � <br /> f � <br /> 250-500 ' <br /> 500-1000 ' ` <br /> xardcover Variance Required: Yes ~ No� Date of Council Approval: <br /> / '`) ; <br /> �rading: Staff Approval Date: �UON�`' By:•�I��..; Council Approval Date: <br /> ��., ,�7 � 1•'..� <br /> � <br /> ::eptic: Staff Approval Date: �����►-�'`a ��r � - By:�" ^ l�t_ - <br /> --- __.. <br /> �oning File: # Resolution #: "! Resolution Date: � <br /> • � f <br /> �tEMARRS (in house) : � <br /> I <br /> 1 <br />