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CHECR OFF LIST FOR ISSUANCE OF PERMITS <br /> ' FOR OFFICE USE ONLY <br /> ADDRBSS OR LEGAL: �� � U ��L.t�Zr u-'C'�'�� ���� P1D= <br /> DESCRI PTI ON OF WORR: ��l��-C.� �-E, ��'- . <br /> �_, <br /> ------------------------- ------------------------------------------------------- <br /> ZONING REVIEW BY: DATE APPROVED: S- IO 'C? � <br /> BIIILDING REVIEW BY: DATE APPROVED: 3 - �b "`�1 3 <br /> FEES TO BE CHARGED: Misc. Fees Ca�cu�ated By: <br /> PERMIT Yes (� No <br /> PLAN REVIEW Yes—� No SEWER CONNECTION _ Pd <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 CHECR LIST Zoning District: �- li� <br /> Fire Department:� n,c, �►c,c� Post Office: �on, (,g.-�� Schoo� District: o�w-�� <br /> Lot Area: G I,(,v y3 Width: �,���C..(� Depth: U�-fL� �e..� <br /> Survey Submitted: Yes D� No Date of Survey: ��5 � 1 �j <br /> Proposed Setbacks: <br /> Front (,ba� : ij Z �~4 Right Side: tic= 3v r <br /> Rear (Street) : ?`� � ""�" Lef t Side: � �6 �`� <br /> Adjacent Structures : N��- Wetland: /U�� <br /> Bui].ding Height: Def . Hgt. 2a � Peak Hgt. �g � <br /> n,�,op os�¢d� <br /> � _ �� <br /> Avg. Setback: � �� Lot Coverage: � `�� w/� ���� <br /> Existing Proposed <br /> Hardcover: �' �N Qc.D� sp�l���c Rf�n t(.a� �Z. _�. -t-r /�C-COwAG� Z�7, 3�6 <br /> s� -�r <br /> 75-250 ' <br /> 250-500 ' <br /> 500-1000 ' <br /> Hardcover Variance Required: Yes No_D� Date of Council Approva�: <br /> Grading: Staff Approva� Date: � -lO'�i� By: �U. Counci� Approval Date: <br /> Septic: Staff Approval Date: /Vl� By: <br /> Zoning File:# � Resolution # : Resolution Date: <br /> REMARKS (in house) : <br />