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s <br /> , � <br /> � CHBCR OFF LIST FOR ISSIIANCE OF P$RMITS <br /> FOR OFFICE USE ONLY <br /> ADDRSSS OR LEGAL: �� S Q - N� PID: _�a - /��- � 3 37' 0403 <br /> � . <br /> DESCRIPTION OF WORR: %�� <br /> ------------------------y-��---------------------------------------------------- <br /> ZONING REVISW BY: �Qn 11[Mnu...._ DATE APPROVED: G' Z(-k� <br /> _�' � <br /> BIIILDING REVIEW BY:� DATE APPROVED: G-L-t -K/ <br /> FSES TO BE CHARGBD: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Yes f 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 CHBCR LIST Zoning District: /1R�1� <br /> Fire Department: LL Post Office: /YI.P School District: p�lO.va . <br /> Lot Area: 2 AL. Width: Z�y � Depth: �b�t <br /> Survey Submitted: Yes 0( No Date of Survey: �`� -`�T <br /> Proposed Setbacks: i <br /> Front (zbaka-�: [05. � Right Side: 27S <br /> Rear (Street) : 3�i. �i Left Side: ��'� � <br /> Adjacent Structures : N Wetland: ,�V�/� <br /> Building Height: Def. Hgt. Pea Hgt. <br /> Avg. Setback: Lo Cover <br /> Existin ropos ; <br /> � <br /> Hardcover: 0-75 ' <br /> 75-250 ' <br /> 250-500 ' <br /> 500-1000 ' <br /> Hardcover Variance Required: Yes o Dat of Council Approval: <br /> Grading: Staff Approval Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File:# Resolution �: Resolution Date: <br /> REMARRS (in honse) : _ � <br /> I <br /> � <br /> 1 <br />