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• CHECK OFF LIST FOR ISSUANCE OF PERMITS /d"S"90 <br /> FOR OFFICE -USE ONLY <br /> .DDRESS OR LEGAL DESCRIPTION: -7 7'o /z )/ <br /> PID: 6AA • �2`'r S . <br /> DESCRIPTION OF WORK: �h a � Ian S -"�`JG' w.a � D� T° ' AO <br /> D M 1 T &xl e'rv'r►eY-" <br /> ------------------ -- -------------------------------------------------------------------- <br /> ZONING REVIEW BY: DATE APPROVED: <br /> BUILDING REVIEW BY: DATE APPROVED: =/6 •C110 <br /> PERMIT ISSUED BY: DATE: <br /> -------------------------------------------------------------- ---- <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes No SEWER UNIT $ <br /> PLAN REVIEW Yes 1.10, No SEWER CONNECTION <br /> STATE SURCHARGE Yes " No WATER CONNECTION <br /> PENALTY Yes No ,./ PARK FEE <br /> SAC Yes No SITE INSPECTION <br /> OTHER (specify) <br /> �-Q <br /> ZONING CHECK LIST -----------------Zoning District /`�-�- -------------------- <br /> Fire Department: L L- Post Office: - School District: d9✓2-JN O <br /> Lot Area: A Width: D Depth: <br /> T <br /> Survey Submitted: Yes- No Date of Survey: 7 - 2 - 87 <br /> o fS <br /> Proposed Setbacks : <br /> Front ' (ha c) : l 2 s Right Side <br /> Rear ( � :� 3� + -� Left Side: �a / <br /> Adjacent Structures: !� yrtlN.�� FfS• Wetland: -'-� <br /> Existing Proposed <br /> Hardcover: 0-75 ' <br /> 75-250 ' A, <br /> Hardcover Variance Required: Yes No !t. Date of Council Approval: <br /> Grading: Staff Approval Date: .-'J`7 O By:,/,V%4� Council Approval Date: <br /> Septic: Staff Approval Date: NO Co^Jj'-�LIC_- By:� <br /> Zoning File: # Resolution #: 'V Resolution Date: <br /> REMARKS (in house) : Om l-M W, (OkI &o-y '1 Tp joA Elrn- 10' J P1'XAe44 TQ /40u.S6 <br /> F,2o�r. (' rCPrCs� . tN1 L� �� �; t{/GSD/� G 5Z-4>rc -5"yu �.� Ply /?,9 6N14a� <br /> P PA_A.1J <br />