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' CHECR OFF LIST FOR ISSIIANCE OF PERMITS <br /> � ' . FOR OFFICE USE ONLY <br /> ADDR$SS OR LEGAL: �'S�S (v��' /�v� /U o _PID: <br /> DESCRIPTION OF WORR: /�Or'3/ rJa� <br /> ZONING REVIEW BY:---�-- -------------DATE APPROVED: !a �4'��3------- -- <br /> BIIILDING REVIEW BY: DATE APPROVED: ( � 'L�-�' � <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT � Yes ✓ � No <br /> PLAN REVIEW Yes v�' 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: (�2-IQ <br /> Fire Department: Gq�/«` Post Office: C.�4x2: School. District: d���b <br /> Lot Area: /6�,6b,3 s�� 'f' Hlidth: Z?o.S1 ` Depth: ��6 • L� � �4UL <br /> Survey Submitted: Yes rC' No Date of Survey: J �z3-�� <br /> Proposed Setbacks: <br /> Front �e') : !ri//i¢ Right Side: t r p ` '� <br /> Rear (�et) : Zs�` -;= Lef t Side: c ZS�+ <br /> Adjacent Structures : yF.:�4-c:�c� Wetland: ��r�{� <br /> Buil.ding Height: Def. Hgt. �. x Peak Hgt <br /> 1 Lo Covera e: % <br /> Avg. Setback: g <br /> xisting , roposed / <br /> , <br /> ; <br /> Hardcover: 0-75 ' ; �•. ' ' <br /> � i -' -�' <br /> 75-250 ' ; <br /> 250-500 ' <br /> 500-1000 ' \� �- ' <br /> 1 <br /> Hardcover Varianc� Require�: Yes No Date of Co�incil Approval: <br /> � <br /> Grading: Staff Ap�roval Dat�: By:;� Counc�l Approval Date: <br /> ; � ; <br /> Septic: Staff App�oval Date:��_ _� BY� <br /> , 1/ Resol� tion Date: <br /> Zoning Fil�e: # � Reso u�ion � : '� <br /> � ' � <br /> ; ; <br /> REM�RKS (in house�a : ' � <br /> � ; <br /> _ 1 � <br />