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� CHECK OFF LIST FOR ISSIIANCE OF PERMITS <br /> . � FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: I S�� /��� � !�2 PID: <br /> DESCRIPTION OF WORR: T/��'s �L'�s�� ' "�c l� � ��v- <br /> ----- -------------------- - <br /> --------------------- • <br /> ZONING REVIEW BY: DATE APPROVED ,�-2�I � Y <br /> BIIILDING REVIEW BY: ( L���iy�.Gw— DATS APPROVED: - Z-� ��7`'j <br /> ---------------------- <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes � No <br /> PLAN REVIEW Yes (/� No SEWER CONNECTION <br /> STATE SURCHARGE Yes-� No WATER CONNECTION <br /> INVESTIGATION FEE Yes No� PARK FEE <br /> SAC Yes No SITE INSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECR LIST Zoning District � `!� _ <br /> Fire Department: �/�- Post Office: �/ � School District: ��G <br /> S -�-Width: Depth: <br /> Lot Area: / 7, � 5 �5 ,�„ <br /> Survey Submitted: Yes� No Date of Survey: �/-��" �� <br /> Proposed Setbacks: , � � <br /> Front (�e) : �O�( % _ Right Side: f� <br /> Rear (�tr.s.et) : �S � "� Left Side: /V d/�-- <br /> Adjacent Structures: �2' Wetland: /V�� <br /> Bui l.ding Height: Def . Hgt. � �(G- Feak Hgt. � /�- <br /> Avg. Setback: /l� l � Lot Coverage: n� �C <br /> Existing Proposed <br /> Hardcover: 0-75 ' <br /> 75-250 ' <br /> 250-500 ' <br /> �00-1000 ' ��� �`f' L�'�'�� <br /> Hardcover Variance Required: Yes No� Date of Council Approval: <br /> Grading: Staff Approval Date:� �i� By� Council Approval Date: <br /> Septi c: Staf f Approva]. Date: N�'g BY= <br /> Zoning Fil.e:# Resolution # : Resolution Date: <br /> REM�I2RS (in house) : , <br />