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��.e !//3 <br /> CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 9i/-5� (,''c{t- PID: 3 /Z 00,z6 <br /> DESCRIPTION OF WORK: F1 1'1 r 5 h e ► Dc(Y <br /> ZONING REVIEW BY: DATE APPROVED: <br /> BUILDING REVIEW BY: DATE APPROVED: 1,1 -2.-67 I <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Yes-1/ No— <br /> es // No SEWER CONNECTION <br /> STATE SURCHARGE Yes--I/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 Dis ict: <br /> Fire Department: Post Office: Schoo . District: <br /> Lot Area: Widt Depth: <br /> Survey Submi -d: Yes No Date of S vey: <br /> Proposed Set ,a• s : <br /> Front ( ak• ) : Right Si -e: <br /> Rear ( ' tree ) : Left S ' '•e: <br /> Adjace t Str ctures : Wetla d: <br /> Building H:fight: 'ef. Hg . P =k Hgt. <br /> Avg. Setba k: Lot Cov rage: <br /> Iiiiring Prop--sed <br /> Hardcover 0-75 ' <br /> 5-250 ' <br /> 2 .0-500 ' <br /> 510-1000 ' <br /> Hardcover Variance Required: es No Date of Counc 1 Approval: <br /> Grading: Staff Approval Date By: Council .pproval Date: <br /> Septic: Staff Approval Date By: <br /> Zoning File:# - -solution #: Resolu ion Date: <br /> REMARKS (in house) : <br />