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CHECR OgF LIST FOR ISS ANCE OF PERMITS <br /> , FOR OFFICE US ONLY <br /> ADDRESS OR LEGAL: yy 6 S a!9 yS//-�C� �oA� PID: <br /> D$SCRIPTION OF WORK: WIA�-e- <br /> -------------------- <br /> -- ----------------- -------------------------- -�_---- <br /> ZONING REVIEW BY: D1ATE APPROVED: �f""��"�"`s � 2 �� <br /> BIIILDZNG REVIEW BY: � DrATB APPROVED: ��� C�' Z I 'SS <br /> ---------------------- - <br /> FEES TO BE CHARGED: Misc. �'ee Ca].cu�ated By: <br /> PERMIT Yes � No <br /> PLAN REVIEW Yes � No SEWE CONNECTION <br /> STATE SURCHARGE Yes�� Na WATE CONNECTION <br /> INVESTIGATION FEE Yes No PA�K EE <br /> SAC Yes No SI E INSPECTION <br /> Number of SAC Units OTHE (specify) <br /> ----------------------------------------r- ----------------------------------- <br /> ZONING CHECR LIST Zoning istrict: <br /> Fire Department• /���- Post Office: I " School District: <br /> Lot Area: 2• l�G�t.�� <br /> Width: Zdb•°!$ Depth: 42�•�Y <br /> Survey Submitted: Yes_�C No Date of; S rvey: <br /> c a -7—! • &� <br /> Proposed Setbacks: � � <br /> .7 <br /> Ri ht Sid � <br /> Front (�e) : 3F5'`1 g <br /> Rear (9�tz-�t.) : 1$' � Lef t Side 32� I <br /> Ac�'jacent Structures : `j0� IWetland: ��� <br /> � Peak H t. ? <br /> Buil.ding Height: Def . Hgt. ��7 (f g <br /> Avg. Setback: �t overage: /'v�//`�" <br /> Existing Pr posed <br /> Hardcover: 0-75 <br /> 75-2 ' <br /> 250- 00 ' <br /> 500- 000 ' <br /> Hardcover ariance eq ired: Y s No ouncil Approval : <br /> Grading: Staff Appr v 1 Date: ' By�: Cou cil Approval Date: <br /> Septic: Staff Appro Date: BY= <br /> Zonin Fil.e: # Res lution Re olution Date: <br /> S (in house) : <br /> I I <br />