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' � � C�?CR OFF LIST FOR ISSIIANGE OF PF.RMITS <br /> FOR OFFICE USE ONLY <br /> �� � �, �� `�-,-�_ . ' �,�. <br /> ADDRESS OR I.EG�L DESCRIPTION: i � �� � t' ' � � ��� �-'� l��- � — <br /> PID: � 7- / �7 � 2 3 �2 00�.� <br /> DESQtIPTION OF WORR: � <br /> C�'..,t�:��E � '`'�1�-`� '-`yt'' t_ !� 'Z- ���l y ,� ��� <br /> ---------------�----------------� <br /> ------- �o" <br /> -------------------- ------------------ - <br /> ZONING R}3�TIEf�I BY: /�i � DATE APPROVED' f� Z S �T I - <br /> BIIII,DING REYIL�F7 BY: � v.�,� .DATE APPROVED: I i 'Z�`' �`"�( <br /> L <br /> pERMIT ISSIIED BY: DATE: <br /> --------------- ---.��------------• <br /> ---------------------------------------- � <br /> FEES TO BE CHARGED: Misc. Fees Calculated By•�`� t'"�'�-� <br /> PERMIT Yes � No SEWER UNIT $ <br /> �` <br /> FZ,AN REVIEW' Yes � No SEW�R CONNECTION <br /> WATER CONNECTION � <br /> STATE SURCHARGE Yes �/ No t <br /> / r` <br /> PENALTY Yes �/ No PARK FEE s <br /> Yes No � SITE INSPECTION s <br /> Sr'�C s <br /> OTHER (specify) , <br /> ZONING CHECK LIST -----------------Zoning District---��`---��----------------- <br /> a <br /> Fire Denartment� �Ou �"'� Post Office• -��fi�'���.=� School District:�'`'�'�'�' ``- ' <br /> � e ' <br /> n �/ �� � � `.� <br /> Lot Area: (/� "i �� c � Width: `���-� Degth: <br /> Survey Submitted: Yes� No� Date of Survey: � - 2�0 - l p - <br /> Proposed Setbacks : <br /> Front (-�� : �n/51`/N� Right Side: �S /"� � � <br /> 5�: 3 3' � � <br /> Rear (��-�-=n�•�K: z3� Left Side: 8� f �./ <br /> Adjacent Structures : A�fr7�'Ac�l�'l.-� Wetland: '--� <br /> Existing Proposed <br /> . �---- <br /> Hardcover: 0-75 ' <br /> o �K <br /> 75-250 ' � ' o <br /> Hardcover Variance Required: Yes No� Date of Council Approval: -�� <br /> Grading: Staff Approval Date: NoN� BY= Council Approval Date: .� <br /> Septic: Staff Agproval Date: --- By� � <br /> Zoning Fil.e: # Resolution # • Resolut�on Date: __ <br /> RRMARK$ �iII house) : <br /> _ .-- - . . 6 -- __...- - -- - . .-------- --_ _ ----- <br /> . _ _. _. ... .._---.. <br />