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�tr - CHECK OFF LIST FOR ISSIIANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> A.DDR.ESS OR LEGAL: ��f y D/��0"1�4 �hl � PID: <br /> D$SCRIPTI ON OF WORR: }�-�'�-� '�'��- — +���-�- D�` �'c T�.D�" !� V R-"`-'r�O s P�Crc <br /> -------------------- ------------------------ <br /> -------------- -- <br /> ZONING REVIEW BY: DATE APPROVED: /V/t9` _ <br /> BIII7�DING RL�TIEW BY: �_ DAT$ APPROVED: /Z'2�- 7 Y <br /> -----------------------• ------- <br /> FEES TO BE CHARGED• Misc. Fees CaJ�culated By: <br /> PERMIT Yes ✓No <br /> PLAN REVIEW Yes cl No SEWER CONNECTION <br /> STATE SURCHARGE Yes L/No WATER CONNECTION <br /> INVESTIGATION FEE Yes No (�- PARK FEE <br /> SAC Yes No ✓ SITE INSPECTION <br /> Number of SAC Units OTHER ( specif y) <br /> -------------------------------------- <br /> ZONING CHECK LIST Zoning District: <br /> Fire Department• Post ffice : SchooJ. District: <br /> Lot Area : Wi th: epth: <br /> Survey Sub ' tted : Yes N Date of S vey: <br /> Proposed S t acks : <br /> Front ( ke) : Right Si e: <br /> Rear ( St eet) : Left Si e: <br /> Adja ent tructures : Wetl nd: <br /> BuiJ.ding eight: Def . H t. Pe k Hgt. <br /> Avg. Set ck: ot Cover ge: <br /> Exis ing Propose <br /> Hardcove : 0-75 ' <br /> 75-250 ' <br /> 50-500 ' <br /> 5 0-1000 ' <br /> Hardcove Variance R q ire : Yes No Date of Counci7� ApprovaJ� : <br /> Grading: Staff Approv Da e: By: ouncil Approva]. Date: <br /> Septic: taff Approval Dat : BY= <br /> Zoning ' le• # R solution � : Resolution Date: <br /> �F.I�tARKS (in honse) : <br />