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, . . .. <br /> ' ' CHECR OFF LIST FOR ISSIIANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: Z�v _��u �/55 l-�eG� iZt,Y PID: <br /> �-� � o� 2cc� �--� �;,g m,� ✓���. c��-.., /o��cC, v���, <br /> DESCRIPTION OF WORR: 3 S � s '� � <br /> ------------------------- ------------------- <br /> ZONING REVIEW BY: DATE APPROVED: 3 �3 U-s y <br /> BIIILDING REVIEW BY: DATE APPROVED: 3 - 3v"�� <br /> -------------------- <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes �/!No <br /> PLAN REVIEW Yes �n No SEWER CONNECTION <br /> STATE SURCAARGE Yes ✓ No WATER CONNECTION <br /> INVESTIGATION FEE Yes No (/" PARK FEE <br /> SAC Yes NoT� SITE INSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ---------------------------------------�------------------- <br /> ZONING CHECR LIST Zoning District: �� � <br /> Fire Department: �' v �ost Of��: � �v �� School Di strict: <br /> Lot Area: I� �C- Width: Depth: <br /> Survey Submitted: Yes� No Date of Survey: <br /> �� �1 LL <br /> Pro osed Setbacks: <br /> P Front (Ir�e) : 7 Z-� f Right Side: � �`� N <br /> Rear (S�eet) : 5 s� '� Lef t Side: /��fE- � <br /> Adjacent Structures: /��7�1��-�E'�� Wetland: <br /> Building Height: Def . Hgt. � -/� Peak Hgt. <br /> Avg. Setback: � Lot Cove�age: <br /> ,Existing Propos d <br /> Hardcover: 0-75 ' <br /> 75-250 ' <br /> 250-500 ' ,. <br /> ;' �..._._._....�.. <br /> 500-1000 ' _;' <br /> Hardcover Variance Required: Yes No Date of Counci� Approva�: <br /> Grading: Staff Approval. Date: By: Council Approval Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File:# ResoJ.ution #: Reso�ution Date: <br /> REMARRS (in house) : , <br /> / <br />