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�.. .� �(�- �� "��� <br /> _��<r_���,��_ _ _ _ _ <br /> � � CHECR OFF I�IST FOR ISSIIANCE OF P$RMITS <br /> � FOR OFFICE USE ONLY <br /> , � <br /> AI7DRESS �R LEGAL: � � c`� ' ) ' PID: Q Sr i'17- �_' � � 2- �-'�C3I,� <br /> DESCRIPTION OF WORR: - ` "� l >'�Z-�'�%�� v <br /> --------------------�-----7--------------------� -----�-- -------------------- <br /> ZONING REVIEW BY: ,�j/�l'���- DATE APPROVED: jd � � _ :��; �� <br /> BIIILDING REVIFW BY: DATE APPROVED: ( u -2-`t 'G O <br /> --------------------- ----------------------------------------T---- <br /> ---------� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: � � � <br /> i <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 i/' SITE INSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ---------------------------------------------------------'--------------------� <br /> ZONING CHECK LIST Zoning District:� ��_ <br /> Fire Department: - Post Office: C. � � - School District: "��"� ��/ -,�'7 <br /> � � � , <br /> Lot Area: 1 �� � � C Width: � ` I ' Depth: �/ .� _ <br /> � � � . <br /> Survey Submitted: Yes No Date of Survey: ��'� �' � " �n �" <br /> � <br /> Pr�pQ sed Setbacks : � � <br /> r 1Front (-3�tke�': 2 / �.� -� Right Side: 2 2r? -�` r �1 <br /> � � � <br /> � , '," <br /> ,,�,,� ear (-�,.�.y....V_�� �;'''� � r,� ��� Left Side: ! � ? � _` �,.r.�,� <br /> Q� � , <br /> Adjacent Structures : �J�-7 � Wetland: <br /> L�'t'rT'G_ C'/�� �// / <br /> ��n + . <br /> Building Height: Def. Hgt. � � FrT� peak Hgt. � <br /> Avg. Setback: Lot Coverage : <br /> Existing Proposed <br /> Hardcover: 0-75 ' <br /> 75-250 ' /�. <br /> 250-500 ' '� . �,;_� : <br /> ; s <br /> 500-1000 ' ' <br /> Hardcover Variance Required: Yes No � Date of Council Approval : + <br /> i <br /> P <br /> Grading: Staff Approval Date: /J �� �r- By: Council Approval Date: } <br /> : <br /> ,J � <br /> Septic: Staff Approval Date:������� '��.�' %- �� � � ' • By: / ✓�: _ � j <br /> ! <br /> Zoning File: # !"� Resolution # : ' Resolution Date: � ; <br /> i <br /> � <br /> REMARRS (in house) : _ <br /> ' `'[�t�' � t � � �" � /� i / a, �', ��� ��Y/1� ',� .�V J�� 1� — `� 2- <br /> V 4 � � i t� <br />