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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br />FOR OFFICE USE ONLY <br />ADDRESS OR LEGAL DESCRIPTION: � Co 2 <br />PID: _ <br />DESCRIPTION OF WORE s Atx> t 'n 0 N� <br />-----Z01916 - - - - - <br />RaviI BYs z/ ---- ------------DATE APPROVEDs 2 45 r EjC} <br />NtMLDIDG REVIEW BY s -DATE APPROVED s �. • Z..i - 5-"-f <br />PERMIT ISSUED BY: DATES <br />----------------------------- <br />FBES TO BE CBARGED: Misc. Fees Calculated By: <br />PERMIT <br />PLViN REVIE'N <br />STATE SURCHARGE <br />PENALTY <br />SAC <br />Yes No <br />Yes ✓ No <br />Yes No <br />. Yesz No <br />Yes Nc. ✓ <br />SEWER 'UNIT <br />SEWER CONNECTION <br />WATER CONNECTION <br />PARR FEE <br />SITE INSPECTIGN <br />OTHER (specify) <br />•----- <br />=ONIt!<'� CBRCE LIST Zoning District: 4 if - / �------------------ Fire Department: Post Officesr4'�/' School Districts <br />Lot Area: . Sf A} c { Width:S &S' f Depth: 431 L. , '2 <br />Survey Submitted: Yesx No Date of Survey: 2 4 y - S 5 <br />Proposed Setbacks: <br />;SFront Fieks)ear (66re") : (rr 5 <br />Adjacent Structures: Wetland: <br />Existing "ruposed <br />Right Sides _ ZLIO r <br />Left Side: J410t <br />Hardcover: 0-75' <br />79-250 _ 0k ��. ± ok <br />.-V > <br />Hardcover Variance Required: Yes_ No Date of Council Approval:-- -- <br />Grading: Staff Approval Dates Or" By: Council Approval Date: <br />Septic: Staff Approval Date: 2 -.JS * BY: -� <br />Zoning Files# Resolution #: Resolution Date: <br />REMRRES (in house) s E O L. Ac f- / <r PP 77C TAN Ar IN I & ' N W o✓ R p wg+ j i�b <br />1A P S fA^ /}�,h ro N <br />