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CHECX OFF LIST FnR ISSIIANCE OF PERMITS <br /> r OR Or r?'CE USE ONLY <br /> P�DRESS OR I�EGAL: "�1 ZC� ���5� f��'lS (�/� PID: <br /> DESCRIPTION OF WORR: 3 S� o^� ���G�'` � �E�lG <br /> -------------------- <br /> ------------------------ ----------- � <br /> Z ONING REFIET�7 BY- DATE APPROVBD: I`�` Z��S J - <br /> 3III�D ING REVIEW BY: DATS APPROVED: -(t' -Z 7 � 3 _ <br /> --------------------- ------------------------------------------------------- <br /> �,�5 � Bg ��- Misc. Fees Calculated By: <br /> PERMIT Yes ��~No � - <br /> PT1AN REVIEW Yes f No SEWER CONNECTION <br /> STATE SIIRCHARGE Yes �/ No WATER CONNECTION - <br /> INVESTIGATION FEE Yes No <-�' PARK FEE <br /> SAC � Yes No �� SITE INSPECTION <br /> Number of SAC IInits OTHER (specify) <br /> ---------------------------- <br /> ---------------------------- <br /> ZONZNG CHECK LIST Zoning District: G�L-/� <br /> Fire Departinent- ✓L(,��� Post Office: ��✓,,.v School District:/2(,0� <br /> Lot Area• /��yS� s� fP" Width: (6S� A v 2 Depth: /��-�� �� <br /> Survey Submitted: Ye��_ No Date of Survey: 3 ' ����7 <br /> � O n-! t�c �L <br /> Proposed Setbacks : ' � y, ` <br /> Front (La�e� : N �h Right Side : $� � <br /> Rear (��t) = 3S� Left Side:�� <br /> Adjacent Structures: /�-r�'�'+G�__ Wetland: /J��- <br /> Bui�ding Height: Def. Hgt. l'.(�. Peak Hgt �-� <br /> �,vg. Setback: �I � Lot Coverage: <br /> Existing Proposed <br /> fiardcover: 0-75 ' � �� <br /> 75-250 ' /-s• � ` � <br /> 250-500 ' �/�' <br /> 500-1000 ' ��� <br /> Hardcover Variance Required: �es No Date o �Cou cil Approval: <br /> Grading: Staff Ap roval Date: y: vunciJ. Approval Date: <br /> Septic: Staff Ap r val Date: BY= � ' <br /> � <br /> Zoning File- � Res�Iution �: � Reso� tion Date: <br /> , ,, <br /> REMARKS (in hons ) : '� .. <br /> ; <br /> � <br /> , � <br /> 1 <br />