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� CHECR OFF LIST FOR ISSIIANCE OF PBRMITS <br /> FOR OFFICE USE ONLY <br /> ALIDRESS OR LEGAL: �1 6 l S l�(�IA(�W c�O�S �(ZPID: ��fl c�- - a3 �/ !�O r �f <br /> DESCRIPTION OF WORR: �1�W �tS — <br /> ----------------------------------------------------------------------------- <br /> ZONING REVIEW BY: DATE APPROVED: <br /> BIIILDING REVIEW BY: ��,�oC��� DATE APPROVED: q' -2�( ' �( O <br /> F$ES TO BE CH,ARG$D: Misc. Fees Calculated By: <br /> PERMIT Yes r� No �� <br /> PLAN REVIEW Yes �/ No SEWER CONNECTION �> <br /> STATE SURCHARGE Yes ,/ No WATER CONNECTION - - <br /> INVESTIGATION FEE Yes No 1� PARK FEE <br /> SAC Yes ✓ No SITE INSPECTION <br /> Number of SAC Units �_ OTHER (specify) <br /> ----------------------------------------g---------_---- --�------------------- <br /> ZONING CHECR LIST Zonin District � j � <br /> Fire Department: L � Post Office: School District: <br /> br�,.�� i <br /> Lot Area:PR� - / �. Width: /�b -,�- Depth: <br /> Survey Submitted: YesJi No Date of Survey: <br /> Proposed Setbacks: � <br /> Front (.i�rc3 : sr Right Side : <br /> Rear (�--'� ) �v� Left S� 3n : S <br /> Adjacent Structures : � _ Wetland: �" <br /> Building Height: Def. Hgt. 2.�j Peak Hgt. 3s <br /> Avg. Setback: Lot Coverage: <br /> Existing Proposed <br /> Hardcover: -7 ' C5 7�e�0 � V(�Iv <br /> 75 0 ' <br /> 2 0 ' <br /> -IO 0 ' <br /> Hardcover Variance Required: Yes No� 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 /> �F.MARKS (in house) : <br />