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CHECK OFF LIST FOR ISSQANCE OF PERMITS <br /> � FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: /,2 S ,�/�Ut"� �C-�.=Z� PID: C'.ri- //�- �Z� - 1/ '�%G%7 <br /> DESCRIPTION OF WORK: C����t�-��-c.�-� <br /> -------------------------------------------------------------------------------- <br /> ZONING REVIEW BY: ��,,;� (Q,{�,�� DATE APPROVED: ((- (S" �7 3 <br /> BIIILDING REVIEW BY: � DATE APPROVED: ��- � s ��7� <br /> FEES TO BE CHARGED: Misc. Fees Ca].culated 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 /> ----------------------------------------g---------�-----�----------------------- <br /> ZONING CHECR LIST Zonin District /QfQ (� <br /> Fire Department: [,•C.,. Post Of f ice: w�z..4�o School Di strict: p�t.0�tsb <br /> Lot Area: �o, �2? 54 � �.Width: �7/ � a' ,g.v�. Depth: /?`'f�� �4V� <br /> Survey Submitted: Yes C No Date of Survey: �• 25 • f� <br /> Proposed Setbacks: <br /> Front (�e) : ( UZ � -� Right Side: ��� SFac <br /> � ��� <br /> Rear (Str'e'�'� : .5"3� Left Side: �2.� <br /> Adjacent Structures: �.� _ Wetland: /i/lj¢ <br /> Building Height: Def. Hgt. V- k. Peak Hgt. <br /> Avg. Setback: ot Cove age: <br /> xisting Propo d <br /> Hardcover: 0-75 ' <br /> 75-250 ' <br /> 250-500 ' <br /> 500-1000 ' <br /> Hardcover Variance equir d: Yes No Date f Council Approval: <br /> Grading: Staff Appr val Da e: B : Council Ap ova� Date: <br /> Septic: Staff Appro aJ. Date: By: <br /> Zoning File:# Reso uti n # : Resolution Date: <br /> REMARRS (in house) : <br />