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� CHECK OFF LIST FOR ISSIIANCE OF PERMITS <br /> . � ' " FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 3C�?� S o.�►,��ye.r 7�4/L PID: (,�`�" //7- a '� -- � '.� ' OL17� <br /> DESCRIPTION OF WORK: IV��� /��S <br /> ---------- - ------------ <br /> ZONING REVIEW BY: DATE APPROVED:° /�• �Q�`�Y <br /> BIIII.DING REVIEW BY: DATE APPROVED: �l�-f�l'S� <br /> --------------- - <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes c/� No <br /> PLAN REVIEW Yes �' No SEWER CONNECTION <br /> STATE SURCHARGE Yes f No WATER CONNECTION <br /> INVESTIGATION FEE Yes No v- PARK FEE <br /> SAC Yes No �---�" SITE INSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECR LIST -----------------Zoning District--- �/C.-/� ------------------- <br /> Fire Department• = Post Office: � School District: C�(1,0/�rU <br /> Lot Area: �.3tf ►�1cX�"S Width: ,?Zo'�' Depth: y6 0 `-� � <br /> Survey Submitted: Yes� No Date of Survey: 9- 3v- Sy <br /> Proposed Setbacks: , , <br /> Front (�k�) : �i�s•5 Right Side: (��3 ^� <br /> � � �' Lef t Side: ZS'v �� <br /> Rear (S���e-�'t) : / �7 <br /> Adjacent Structures: lrtj�� Wetland: �� r <br /> Building Height: Def. Hgt. 3p' Peak Hgt. 3"] � " <br /> Avg. Setback: iV lV�' Lot Coverage: N�00� <br /> Existing Proposed <br /> Hardcover: 0-75 ' <br /> 75-250 ' <br /> 250-500 ' <br /> 500-1000 ' <br /> Hardcover Variance quired: Y s o Date of Council Approval : <br /> Grading: Staff Approval Date: ��-i�'- ti By:��� Council Approval Date: <br /> Septic: Staff Approval. Date: /f� -�7�"`�� BY= S-w - <br /> Zoning File:# ""-- ResoI.ution # : � Reso�ution Date: � <br /> �T�tAR�S (in house) : <br />