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� ' CHECR OFF �rIST yOR ISSUANCE OF PERMITS <br /> • ► FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 3�� �,� � � PID: Zv� � l��� Z3 ' 3 2 `C�C� <br /> DESCRIPTION OF WORK: �s� blc�m,Q <br /> ------------------------------------------------------------------------------- <br /> ZONING REVIEW BY: DATE APPROVED: � 2- I -9 2 <br /> BDILDING REVIEW BY: DATE APPROVED: ( 2-t - �r 2-- <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 /> -------------------------------------------------------�1------------------------ <br /> ZONING CHECR LIST Zoning District: �/<-/� <br /> Fire Department: G Post Office: �,ar �� SchooZ District: ��,�J <br /> Lot Area:is o g� .� �,Y 6 4�1Width: Z 7 2• "]Z Depth: S 5 3 <br /> Survey Submitted: Yes �C No Date of Survey: 10-�k-S z <br /> Proposed Setbacks: <br /> Front (�a�) : KI . Z � Right Side:� �yb,� <br /> Rear (�t) : 3C�C�� + Left Side�30•S <br /> Adjacent Structures: /1///� Wetland: Zoo�-� <br /> � <br /> Bui�ding Height: Def . Hgt. Peak H <br /> � <br /> Avg. Setback: Lot Coverage. <br /> Ex' ting P oposed <br /> Hardcover: 0-75 ' <br /> 75-250 ' <br /> 250-500 ' <br /> 5 0 0-10 0 0 ' � ------ <br /> Hardcover Varianc Requi ed: Y s No Date of ouncil Approva�: <br /> Grading: Staff A proval ate: By. Cou cil Approval Date: <br /> Septic: Staff A rova� D te: By: <br /> Zoning File: # Res lut on # : Resol.ution Date: <br /> REMARRS (in ho se) : � <br />