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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> Z <br /> ADDRESS OR LEGAL: `t y O V� 1F�'C2'CPc9 —PID: <br /> DESCRIPTION OF WORK: __ ____ _ <br /> ------------------- ---- --------------DATE APPROVED: --- <br /> ZONING REVIEW BY: <br /> K ? <br /> BUILDING REVIEW BY: oil <br /> DATE APPROVED: <br /> _ ----- <br /> ------------------------ <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓• No <br /> PLAN REVIEW Yes � No SEWER CONNECTION <br /> ✓ No WATER CONNECTION <br /> STATE SURCHARGE Yes No PARK FEE <br /> INVESTIGATION FEE Yes SITE INSPECTION <br /> SAC Yes NO OTHER (specify) <br /> s ecif ) <br /> Number of SAC Units ------------------------- <br /> ----------------- <br /> Zoning District: <br /> ZONING CHECK LIST <br /> (Z- 1 <br /> Fire Department: LL <br /> Post Office: L L School District: on,c�ro <br /> Lot Area: 1 fs.o O Sti :1r. Width: ) ny Depth: Iwo <br /> Survey Submitted: Yes_ A No Date of Survey: <br /> Proposed Setbacks: fi 1'J��"Right Side: �Z <br /> Front (-La4ee+= � <br /> Rear (Street) : <br /> Al Left Side: <br /> Adjacent Structures: /0 <br /> ' Wetland: <br /> Building Height: Def. Hgt. O <br /> Peak Hgt. �• � <br /> Avg. Setback: of Coverage <br /> Existing Proposed <br /> Hardcover: 0-75 ' <br /> 75-250 ' <br /> 250-500 ' <br /> 500-1000 ' <br /> Hardcover Varianc IB Requi ed: Y s No ate o oun it Approval: <br /> Grading: Staff A royal D te: By: Council pp <br /> royal Date: <br /> Septic: Staff Ap roval Dat <br /> Zoning File:# Re lu 'on i Resolutio Date: <br /> REMARKS (im hous ) : <br />