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. CHECR OFF LIST FOR ISSIIANCE OF PERMITS <br /> • ' ' FOR OFFICE USE ONLY <br /> AD�RRSS OR LEGAL: �1 �C��� PID: � �� " �� � - �_� y�l ��;�.�:L <br /> D$SCRIPTION OF WORR: `�(�-� ��<<��2�'e/ <br /> -------------------------- ---------------------------------------------------- <br /> ZONING REVIEW BY:_ ��_ DATE APPROVED: �" 2�' c7 `� <br /> BIIILDING REVIEW BY: ' DATE APPROVED: �'l � z 3 �� � <br /> FE$S TO BE CHARGED: Misc. Fees Ca]�culated By: <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 /> ------------------------------------------------------------------------------- <br /> ZONING CHECR LIST Zoning District: L/Z-1� <br /> Fire Department:_�/��_ Post Office: Vl'lbu� Schoo� District:�y�.,r�Jd <br /> Lot Area: ����£S� Width: s`� Depth: �(../'��v��-�. <br /> Survey Submitted: Yes x No Date of Survey: 3- Z y-�r`� <br /> Proposed Setbacks : <br /> , <br /> g�er�-t (L,a�e) ; (2,��2 2`� 5 �- Right Side: F1�S� <br /> Re�r- (Street) : ���� Lef t Side: 3� w es� <br /> Ad j acent Structures: /I/�/� Wetland: /�/�/� <br /> Buil.ding Height: Def . Hgt. Peak Hgt. <br /> Avg� Setback: ��" Lot Coverage: D . �� <br /> Existing Proposed <br /> Fiardcover : 0-75 ' <br /> 75-250 ' ZI .(07 �a <br /> 250-500 � ll . �5 �o <br /> 500-1000 ' <br /> �-:ardcover Variance Required: Yes No ;'?� Date of Council. Approva�: <br /> Grading: Staff Approval Date: By: Counci� Approval Date: <br /> Septic: Staff Approval. Date: /l��� By: <br /> ".�ning Fi�e: # I�1 �� Resolution # : _�'`�-�/ Resolution Date: <br /> ,,*:@�ARRS (in house) : ��.SC�-S-,v T i v�1� c((�U�, {�� <br />