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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 4-1 5 <br /> O W coo °t-}I t.t_ PID: <br /> -vt�.o /14\r00/+R.r'j�-t„ C3ASQ vY /-r.v t 5/4 <br /> DESCRIPTION OF WORK: --------------------------- <br /> ------ <br /> --------------- <br /> ---------- DATE APPROVED: ilJ(�- <br /> ZONING REVIEW BY: <br /> DATE APPROVED- (0- 2.---5.c- <br /> . <br /> o- 2--5S <br /> BUILDING REVIEW BY: __ _____ -PROVED------------------------- <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes i/No <br /> PLAN REVIEW Yes L/' No SEWER CONNECTION <br /> No WATER CONNECTION <br /> STATE SURCHARGE Yes No--L--, <br /> PARK FEE <br /> INVESTIGATION FEE Yes <br /> SAC Yes No G.------ SITE INSPECTION <br /> Number of SAC Units OTHER ( specify) <br /> ZONING CHECK LIST <br /> Zoning District: <br /> Fire Department <br /> Post Office: c ool District: <br /> Lot Area: <br /> Width: Depth: <br /> Survey Submi •te4; : Yes • <br /> Dat= of Surve : <br /> Proposed Se • •ac s : R' .ht Side <br /> Front Lak- ) : <br /> Rear lStr=et) : eft Sid=: <br /> Adja•ent '•tructurt-s <br /> Wetland <br /> Building leig : <br /> Def Hgt. illir Peak gt. <br /> Lot Coverage: <br /> Avg. Set•ack: Proposed <br /> roposed <br /> Hardco er: 0 75 ' <br /> 75- '50 ' <br /> 250- 00 ' <br /> 500- 000 ' <br /> Har.co er V. ria ce Requi ' ed: Yes No Date f Council Approval: <br /> Gr-di g: St:ff Approval Date: By: <br /> ouncil Approval Date: <br /> Se;•t c: Sta f Approval 'at= : By: <br /> Z•n ng <br /> File:# 'resolution # : esolution Date: <br /> REMARKS (in house) : <br />