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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> o ?'a�Kr¢.t,✓/-F- <br /> ADDRESS OR LEGAL: S� PID_ - <br /> DESCRIPTION OF WORK: __ _ ____ <br /> --------------------- -- -------------DATE APPROVED-.-------------------------- <br /> PPROVED:--------- ------------- <br /> ZONING REVIEW BY: <br /> �"— DATE APPROVED: <br /> BUILDING REVIEW BY: -------------------------------------- <br /> ------------- <br /> -------------------------- <br /> _ _ __ __ -------------- <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes <br /> � Nod>�L491� �w�-,'t' <br /> EW Yes No ✓' SEWER CONNECTION <br /> PLAN REVI WATER CONNECTION <br /> SURCHARGE Yes i <br /> STATE SURCH No rpp,RK FEE <br /> INVESTIGATION FEE Yeses No S TE INSPECTION <br /> SAC YNo <br /> O HER (specify) <br /> Number of SAC Units ----------------- <br /> ___ _ ----------- <br /> ZONING CHECK LIST <br /> Zong District: <br /> Fire Department: <br /> Post Offic cho 1 District: <br /> Lot Area: <br /> Width: D pth: <br /> Survey Submitte Yes <br /> No Da e of Surve <br /> Proposed Setba k R ght Side: <br /> Front (L ke : <br /> Rear (S ree ) : eft Side: <br /> Adjace t St uctures: Wetland: <br /> Building H ig <br /> ht• Def. Hg Peak Hgt <br /> Avg. Setb ck: L Coverage: <br /> Exi ing sed <br /> Hardcov r: 0-75 ' <br /> 75-250 ' <br /> 250-500 ' <br /> 500-1000 ' <br /> Hard ver Varian e equire Yes No <br /> Date of Cc ncil Approval: <br /> Grad ng: Staff A p oval D e: By: <br /> Counci Approval Date: <br /> Sep ic: Staff Approval Da e: By: <br /> Zoning File:# es lution # • Resolution Date: <br /> REMARKS (in house) : <br />