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+ CH$CR OFF LIST FOR ISSIIANCE OF Pffi2MITS <br /> � <br /> FOR OFFICE USE ONLY <br /> ADDRBSS OR LEGAL: �--� _- � "7 I� �):�,`) ! .I ;;0��-`PID: D� I��/- <_:' ' ' j� ,%�-�, �-- <br /> DESCRIPTION OF WORR: � �'� !=. ''.. '=+C,���'-:� ��. , `, <br /> ------------------------�--- -------------------------------------------------- <br /> Z ONING REVIEW BY: � f tf� DATE APPROVED: �' - � � ;�� <br /> BIIILDING REVIEW BY: DAZ'E APPROVED: I� - Z-GL� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By f%��` <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 /> ----------------------------------------g---------_--------------------------- <br /> ZONING CHECR LIST Zonin District.7� � �::� <br /> Fire Department: �� �-- Post Office: l-`,�� ��l School District: ����' ��� �<� <br /> .� , r <br /> Lot Area: � `'`? .� Width: f --' Depth: f,�� -� <br /> Survey Submitted: Yes� No Date of Survey: `�- <�`� ' ���-�� <br /> Proposed Setbacks : � � .� � <br /> Front -�ke-) : �� Right Side: .�..� C� <br /> ' � � .� .� <br /> Rear (�'�ee�) : ,,�� � � Left Side: � <br /> Adjacent Structures : � �� Wetland: <br /> Building Height: Def. Hgt. ' Peak Hgt. � <br /> � � �-- '' � <br /> Avg. Setback: = Lot Coverage: �-� ' -% - <br /> Existing Proposed <br /> Hardcover: 0-75 ' <br /> 75-250 ' ,` � �� ; <br /> _ <br /> 250-500 ' � �` <br /> , � � <br /> 500-1000 ` <br /> Hardcover Variance Required: Yes No� Date of Council Approval: "'"" <br /> , ,. <br /> > <br /> Grading: Staff Approval Date: .��?� -'�' By. „�'��� ` � Council Approval Date: <br /> Septic: Staff Approval Date: ----- BY: ` ' <br /> Zoning Fi le: � J �� Resolution #: �.' ��'�.� Resolution Date: � - r�� ' '+ � ' <br /> REMARRS (in house) ��,. , �, .�I !' =�i,,. ' r , .�j , � ,L '/ f'f . � � �' � <br /> � <br />