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4 � <br /> � . � CHECR OFF I�IST FOit IS9IIANCE OF PERMITS <br /> FOR OFFICE. USE ONLY . <br /> ADDR$SS OR LEGAL: y 0 s-ru e�s t�y R-�A� PID= <br /> DSSCRIPTION OF WORK: I�pDiTplv <br /> ------------------------------------------------------------------------------- <br /> ZONING REVIEW BY: DATS APPROVED: �'-Z.�-�}'L <br /> BIIILDING REVIEW BY: DATS APPROVED: � -2 S -`I'L� <br /> FEES TO BE CHARGF.D: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No � <br /> PLAN REVIEW Yes� No SEWER CONNECTION <br /> STATE SURCHARGE Yes-� No WATER CONNECTION <br /> INVESTIGATION FEE Yes No� PARR FEE <br /> SAC Yes No � SITE INSPECTION <br /> Number of SAC Units OTHER (specify) <br /> --------------------------------- ------- , <br /> ZONING CHECR LIST Zoning District: Q�-1(3 <br /> Fire Department: Post Office: /V � School District: /r/�L <br /> Lot Area: ��� Width: Depth: <br /> Survey Submitted: Yes� No Date of Survey: 9• 21 -�IO t�n� �'�C� <br /> Proposed Setbacks: <br /> Front (�s) : /�//�1 Right Side: S 7v �-�- <br /> Rear (�rz�t) : Zp0 �'f' Lef t Side: /�/�/�D ��" � <br /> Adjacent Structures:�-7774�1fEb Wetland: /I/fi4 � <br /> Building Height: Def. Hgt. D� � Peak Hgt. <br /> Avg. Setback: L C verage: <br /> Ex ting Pr posed <br /> Hardcover: 0-75 ' <br /> 75-250 ' <br /> 250-500' <br /> 500-1000 ' <br /> .�--- _ <br /> Hardcover Varia e Requ red: es No Date of C uncil Approval: <br /> Grading: Staff Approval Date B : Coun il Approval: Date: <br /> . <br /> Septi c: Staf f Approva7� Dat : BY: <br /> Zoning File # esol.0 on �: Re ol.ution Date: <br /> R�IARRS ( ' house) : <br />