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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 5 tS w• Ltt# /''' /a• PID: 4'2 - Ili" a3 al 006 g <br /> DESCRIPTION OF WORK: 3- Qom-.- / c`'L e.4— <br /> ZONING REVIEW BY: eio DATE APPROVED: LI ^ K.-C Z <br /> BUILDING REVIEW BY: o 1 a1 DATE APPROVED: 1-4 - cc- 57_ <br /> FEES TO BE CHARGED: / Misc. Fees Calculated By: <br /> PERMIT Yes r/ No <br /> PLAN REVIEW Yes 1.,"- No SEWER CONNECTION <br /> STATE SURCHARGE Yes ✓ No WATER CONNECTION <br /> INVESTIGATION FEE Yes No v" PARK FEE <br /> SAC Yes No P' '' SITE INSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECK LIST Zoning District: (62-11 <br /> Fire Department: yV1Aevr1O Post Office: /✓(C School District: /WI:. <br /> Lot Area: LIIy, W/SSacAes Width: 6,6 ' Depth: l2o .3' ' <br /> Survey Submitted: Yes Q( No Date of Survey: Z- 1Z _g 2 <br /> Proposed Setbacks: <br /> Front (Irn e) : ti /li- Right Side: ae0'-t. <br /> Rear (Street) : ?65'± Left Side: 3')01-1. <br /> Adjacent <br /> ')O'- <br /> Adjacent Structures : A 7-rinc,M-eJ Wetland: 75-0 ' -1 <br /> Building Height: Def . Hgt. 62 /c Peak Hgt. <br /> Avg. Setback: 4,41//9 Lot Coverage: <br /> Existing Proposed <br /> Hardcover: 0-75 ' t <br /> 75-250 ' ¢ / <br /> F <br /> 250-500 ' 1 <br /> 500-1000 ' I <br /> 1 1 <br /> _ Hardcover Variance Re.uired: " Yes _ NQ Datg--of Council Approval: <br /> Grading: Staff Approval Date `, <br /> / ` By: //�" Council Approval Date: <br /> Septic: Staff Apprgval Dater 71: <br /> Zoning File:# / Re-o4uti. #: / / Resolution Date: <br /> REMARKS (in house) : • <br />