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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE US <br /> E ONLY �J <br /> ADDRESS OR LEGAL: � 5�� 0) 04, Qv PID: ��I I ��a ` - 06 /4' <br /> DESCRIPTION OF WORK: &44c _4 <br /> ZONING REVIEW BY: ,164 DATE APPROVED: <br /> BUILDING REVIEW BY: O &/w .— DATE APPROVED: 1 - ?-93 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Yes ' No SEWER CONNECTION <br /> STATE SURCHARGE Yes ✓ No WATER CONNECTION <br /> INVESTIGATION FEE Yes ✓k No PARK FEE <br /> SAC Yes No SITE INSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECK LIST Zoning District: <br /> Fire Dep. tment: Post Offic : School . tstrict: <br /> Lot Area Width: •Depth: <br /> Survey Su'•mi' ted: Yes No Date f Survey: <br /> Proposed .etb-cks: <br /> Fron (La e) : Right Side: <br /> Rear (Stre=t) : Left Side: <br /> Adja ent Str• ctures: — Wetland: <br /> Building eight: D-f. Hgt. Peak Hg' <br /> Avg. Setb• ck: Lot Coverage: <br /> E isting Proposed <br /> Hardcover 0-75 ' <br /> 5-250 ' <br /> 2' 0-500 ' <br /> 501-1000 ' <br /> Hardcover Variance Required: Y:s No D-te of Council Appro al: <br /> Grading: -taff Approval Date: By: Council Approval Date: <br /> Septic: S •aff Approval Date: B, : <br /> Zoning Fi e: # Resolu ion #: Resolution Date <br /> REMARKS (in house) : <br />