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• , CHECR OFF LIST FOR ISSIIANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> r <br /> ADDRSSS OR LEGAL: ,2/G �I ,<LC��1��4 ��c /�" � . PID: ���-//�'- �3 �c/ G c-'/� <br /> DESCRIPTION OF WORK: �C-c,�� /C�e ��L� ;�'��k-� <br /> --------------------- --- ------------------------------------------------------ <br /> ZONING REVIEW BY: DATE APPROVED: � l ' Z -`i 3 <br /> BDILDING REVIEW BY: �' -�, DATE APPROVED: ( � � �` �► � <br /> -----------------------� ------------------------------------------------------- <br /> FEES TO BE CHARGED: Misc. Fees Calcu].ated By: <br /> PERMIT Yes ✓�l No <br /> PLAN REVIEW Yes ✓� No SEWER CONNECTION <br /> STATE SURCHARGE Yes ��'""� No WATER CONNECTION <br /> INVESTIGATION FEE Yes No r--`"" PARK FEE <br /> SAC Yes�_� No SITE INSPECTION <br /> Number of SAC Units � OTHER (specify) <br /> ------------------------------------------------------------------------------- <br /> ZONING CHECR LIST Zoning District: 1� ~i �`� <br /> Fire Department: ` • Nc ' c.E Post Office: ' 4��t SchooJ, District: �,=t���- �% <br /> Lot Area: ��, ,3c� sS �-T f Width: � `�y.S�i � � Depth: Z�Z . 3�., �v�Q <br /> Survey Submitted: Yes x No Date of Survey: t;:� - z!-'�3 <br /> Proposed Setbacks: <br /> Front (-�e-) : �- Z ' �- Right Side: ��v� (-�=� <br /> , � ��` ,. <br /> Rear (St�eet) : i�4'� �� Lef t Side: � -> � <br /> Adjacent Structures : /'t;� -/+ Wetland: i'"L'.�/�-� <br /> Bui�ding Height: Def . Hgt. <=� Peak Hgt. �, <br /> i <br /> Avg. Setback: Lot Cov rage: i <br /> ��isting � Propo ed �— <br /> Hardcover: 0-75 ' / <br /> / <br /> �75-250 ' � <br /> � <br /> 250-500 ' � ;� <br /> / <br /> 500-1000 ' <br /> Hardcover Variance Required Y s No � D e of Counci Approva� : <br /> Grading: Staff App ova]. Date. By: CounciZ A proval Date : <br /> Septic: Staff Appr val Date: fU f (� By: <br /> Zoning Fi�e: # so� tion #: ' Resolution Date: <br /> REMARRS (in house) : <br /> F � <br />