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�,► <br /> CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONL Y <br /> ADDRESS OR LEGAL: b S .S'T v(�6S bAti CLe� <br /> PID: <br /> DESCRIPTION OF yVO.RK eT�c�� C�A(i�e <br /> -------------------------------------------- -----------------_------------------------------- _ <br /> ZONING REI�IEW BY: �, DATEAPPROVED: �-� •o�i <br /> BUILDING REVIEW BY: DATEAPPROVED: '7- b--��-( <br /> ------------------------- <br /> FEES TO BE CHARGED: Misc. Fees Calculatecf By: <br /> PERMIT Yes f No <br /> PLANREVIEGV Yes � No SEWER CONNECTION <br /> STATE SURCHARGE Yes_� No WATER COMVECTION <br /> INVESTIGATION FEE Yes No ✓ PARK FEE <br /> SAC Yes No�� SITEINSPECTION <br /> Nacmber of SAC Units OTHER (specify) <br /> ZONING CHECK LIST Zoning District.• <br /> Fire Deparhnent: Post Office: Sc{iool Dish•ict.• <br /> Lot AreR: Sg.ft. Acres Y�idth Depdt <br /> Sacrvey Sc�brnitted: Yes s� No Date of Sc��vey: aw f-�� <br /> Proposed Setbacics: <br /> Front(Lc�ke): l y0 �� Rig/1t Side: (0 � <br /> Rear(Street): Z3C�� t Left Sicfe: �5�� � <br /> Adjacent Structures: (a 5� � Wetland.• it//A <br /> Bc�ilding Height: Def. Hgt. I� Peak Hgt. � Z <br /> Lot Coverage: N I� <br /> Gr•acfing: Staff Approval Date: — By: Council Approvc�l Date: <br /> Septic: Sraff,�pproval Dc�te: — BY� <br /> Zoning File: # — Resolz�tion: # Resok�tion Dc�te: <br /> Sl:oreland Dish•ict: ,�1(� <br /> Avg.Setback: BIufJ'SetbRck: LotCoverage: <br /> Existing Proposect , <br /> Har�icover.• 0-75' <br /> 75-250' <br /> 250-500' <br /> S0a-1000' <br /> Hardcover Variance Reqi�ired: Yes No Date of Council Approval: <br /> REMARKS(in house): <br /> 31 <br />