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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> f <br /> FOR OFFICE USE ONLY <br /> %DRESS OR LEGAL: �Q,�.S� ,e /�--I�,- PID: �I /�7"' ✓ ©613(v <br /> DESCRIPTION-OF-WORK---- � .� <br /> ---- �[� � �"t ------------------- <br /> ZONING REVIEW BY: - DATE APPROVED: <br /> BUILDING REVIEW BY: DATE APPROVED: <br /> ------------- ----- <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> ?ERMIT Yes ✓ No <br /> PLAN REVIEW Yes P,*- No SEWER CONNECTION <br /> STATE SURCHARGE Yes *--'- No WATER <br /> RFEENNECTION <br /> AF <br /> INVESTIGATION FEE Yes No t/ <br /> SAC Yes No ✓ SITE INSPECTION <br /> --------------------------------------------------------umber of SAC Units OTHER (specify) <br /> -ONING CHECK LIST Zoning District: C_/z -1 L <br /> Fire Department: /'(/!> PO4;t l0� School District: <br /> ,ot Area: &0'q5-& Width: t6 3.Yl' Depth: 3 y 3•`/ 3 <br /> irvey Submitted: Yespe- No Date of Survey: <br /> =oposed Setbacks: 1 <br /> Front (fie) : log + Right Side: SO <br /> Rear (St�t) : ZLIO + Left Side: <br /> Adjacent Structures : Wetland: /✓�/g' <br /> iuilding Height: Def . Hgt. (, K, Peak Hgt. <br /> vg. Setback: Al//0- Lot Coverage: <br /> Existing Proposed <br /> ardcover: 0-75 ' <br /> 75-250 ' <br /> 250-500 ' <br /> 500-1000 ' <br /> Hardcover Variance Required: Yes <br /> NoY- Date of Council Approval:__ <br /> trading: Staff Approval Date: By: Council Approval Date:/ � <br /> - epti c: S taf f Approval Date:— /'119By: <br /> .zoning File:# Resolution 'r: Resolution Date: <br /> `IEMARKS (in house) : <br />