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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 21 L0 k-^-.)14-` Cek-"� PID: <br /> DESCRIPTION OF WORK: (1. ---1",_„,,,-(7 �A-t-L A DO 1-1,--t.....---)4-042, <br /> ZONING REVIEW BY: Al ` DATE APPROVED: <br /> / DATE APPROVED: 6 -Z 9 y <br /> BUILDING REVIEW BY: /I __„, , it <br /> TEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes No <br /> PLAN REVIEW Yes No L SEWER CONNECTION <br /> STATE SURCHARGE Yes 7No WATER CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITE INSPECTION <br /> Number of SAC Units OTHER (specify) ;'l <br /> , - <br /> ZONING CnECR LI' 1 Zoning District: <br /> I <br /> Fire Department: <br /> Post Office: / School Distilict: <br /> Lot Area: Width: / Depth: / I <br /> Survey Submitte. : Yes No /Date of/Survey: <br /> I <br /> I/ <br /> Proposed Setbac s: <br /> Front (Lak - ) : Right hide: <br /> Rear (Street) : / Left tide: <br /> Adjacent truc •ures: / <br /> Wetland: <br /> Building Heig t: De . Hgt. ' /___ , <br /> Peak Hgt. 1 <br /> 1 <br /> I <br /> Avg. Setback: Lot Coverage: I <br /> a istin Proposed <br /> Hardcover: 0 . 75 ' <br /> 75 250 ' / <br /> 250 500 ' / <br /> r <br /> 500 1000 ' <br /> !! I/ <br /> Hardcover ariance Recuir d: Ye Date of Council Approval : <br /> r--- 1 <br /> Grading: aff Approval D te: / / By: Council Approval Date: <br /> Septic: S aff Approval] Dalte: / / By: <br /> Zoning Fi e:# Resolution /4 : Reso .ution Date: <br /> REMARKS in house) : ,% <br />