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41- CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 4421' (.ve5T ( 4Ncti r2 PID: <br /> DESCRIPTION OF WORK: (24:73o-L- / <br /> ZONING REVIEW BY: �,/66_ . DATE APPROVED: /-,3'51 <br /> BUILDING REVIEW BY: / // // DATE APPROVED: /-3- c <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 No PARK FEE <br /> SAC Yes No SITE INSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECK LIST Zoning District: <br /> Fire Department: Post Office: School ' strict: <br /> Lot Area ► Width: •epth: <br /> Survey -ub �'C/ ted: 1 es No Date of Surv= y: <br /> Proposed - k •ack <br /> Fro (L=ke : Ri•- t Side- <br /> Rear (Stree ) : L=ft Side- <br /> Adjacent S iuctur=s: Wetl.nd: <br /> Building Height Def. ' gt. P-ak Hgt. <br /> Avg. Setback: Lo, D. erage: <br /> Exis .'ng •ro•osed <br /> Hardcover: 0-7 ' <br /> 75-2561 <br /> 250-500 ' <br /> 500-1010 ' <br /> Hardcover Var ance Required, Yes No Date of Counci Approval: <br /> Grading: Staff Approval Date: By: Council A royal Date: <br /> Septic: Staff Approval Date: By: <br /> Zoning File:# Resolution - F#:Cn Resolution Date: <br /> REMARKS (in house)K— <br /> /" �O C t TION 6rAy <br /> 4 - ff oN Pow o niat A,,A1r <br />