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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> t PID: ®(0 `/� 7- '1- 2.l <br /> ADDRESS OR LEGAL: ,�/� � � 3 /4/ ea,' <br /> -1 <br /> OF WORK: <br /> ---------------------------------------------------- -----— <br /> ,� -------- ---------- <br /> ZONING REVIEW BY: , DATE APPROVED• <br /> II <br /> BUILDING REVIEW BY: DATE APPROVED: <br /> ---------------------- -------------------------------------------- ---------- <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes No <br /> PLAN REVIEW Yes c/ No SEWER CONNECTION <br /> STATE SURCHARGE Yes-_e,,- 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 CHECK LIST Zo in District: <br /> Fire Depar n ost Off ' c • of is rict: <br /> Lot Area Wi ept <br /> Survey Submitted: Yes KNo Date of Survey: <br /> O!,.3 <br /> Proposed Setbacks: ( ,+ <br /> Front (-Le) : //�� Right Side: 42 <br /> Rear 2.1401 `- Left Side: //AD/ <br /> Adjacent Structures: Wetland: r/d <br /> Building Height: Def. Hgt. Peak Hgt. �.(< <br /> Avg. Setback: of Coverage: <br /> Existing Proposed <br /> Hardcover: 0-75 ' <br /> 75-250 <br /> 250-5 0 ' <br /> 500-1 00 ' <br /> Hardcover V riance equi ed: Y s Date o Council Approval: <br /> Grading: aff App val Date: By: C uncil Approval Date: <br /> Septic: taff Appr val Date: By: <br /> Zoning ile:# Re olut'on #: Resolution Date: <br /> REMARK (in house) i 4 <br />