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� CgECR OFF LIST FOR ISSIIANCE OF PERM3TS <br /> � FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: Z�t Z� C^—��'` `�� PID: <br /> DESCRIPTION OF WORR: CA'����T <br /> -- --- <br /> ----------DATE--- <br /> -------------------- APPROVED: C9• 2' ciS` <br /> ZONING REVIEW B`�: <br /> BIIILDING REVIEW BY: DATE APPROVEI7: 6 " 2` 5 S <br /> -------------------- <br /> --- --------------- <br /> PEES TO BE CHARGED• Misc. Fees Ca�culate y: <br /> PERMIT Yes �No <br /> PLAN REVIEW Yes f�Ia SEWER CONNECTION <br /> �/�Na WATER CONNECTION <br /> STATE SURCHARGE `leS pp,gg FEE <br /> INVESTIGATION FEE `�eS N� SITE INSPECTION <br /> SAC Yes No <br /> OTHER (specify) <br /> :�Iumber of SAC Units ------------------------ <br /> ----------------------------- <br /> ------------ �/1,_)� <br /> ZONING CHECR LIST <br /> Zoning District: <br /> P st Off ' e: S ol i trict: <br /> Fire Depart:�ent: � <br /> Lot Area : <br /> dth: Depth: <br /> Survey Submitted: Yes No D�. Date of Survey: <br /> � <br /> Yria�� s �- °� �-�J�» �ti <br /> Proposed Setbacks : Right Side- ��d ��' � <br /> Front (L'�k'e) : N �a <br /> Rear ( ��� ' �y�� % Left Side: N � � <br /> Adjacent Structures : � <br /> � �-F Wetland: � �� <br /> Building Height: Def . Hgt. � • � <br /> Peak Hgt. <br /> Avg. Setback: Lot Co era e: _.---- <br /> Existin Pro ose <br /> Hardcover: 0-75 ' <br /> 75-250 ' <br /> 250-500 ' <br /> 500-1000 ' <br /> Hardcover Variance Re uired: Yes No <br /> ate of Coun il Approval :�_ <br /> Grading: Staff Appro al Date: BY' <br /> Counci Approval Date : <br /> Septic: Staff Appro aI. Date: By= <br /> Zoning <br /> File: # Reso tion � Res I.ution Date: <br /> g�RgS (in house) : � <br />