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� � � CHECR OFF LIST FOR ISSIIANCE OF PERMITS <br /> FOR OFFICE. USE ONLY <br /> ADDRESS OR LEGAL: �Z� ��'�'�'Q� '�'` pID' <br /> DESCRIPTION OF WORK: ���i vv/�/ <br /> ------------------------------------� <br />--------------------- ---- ^ . <br /> ZONING REVIEW BY: DATE APPROVED: �f- f Z ' � <br /> BIIII.DING RLrVIEW BY: DATS APPROVED: � ` (2�-��� <br /> ----------------- --- <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Yes v' No SEWER CONNECTION <br /> STATE SURCHARGE Yes �-l�No WATER CONNECTION <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SITE INSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECR LIST Zoning District /�/�. IQ <br /> Fire Department: Pos �f ' �choo� District: <br /> Lot Area: Widt : % pth: <br /> Survey Submitted: Ye�� No Date of Survey: 3 3- lo�j <br /> � o�v r,t...�T" <br /> Proposed Setbacks: � � � <br /> Front (I,�ke) : � f Right Side: <br /> Rear (S�r�e�) : ��� �± Lef t Side: /U � <br /> Adjacent Structures: ?�� �" Wetland:_/�/ V�" <br /> Buil.ding Height: Def . Hgt. � ' �`� Peak Hgt. �� �'' <br /> Avg. Setback: L t Covera e: <br /> Existing Propose <br /> Hardcover: 0-75 ' <br /> 75-250 ' <br /> 250-500 ' <br /> ��� <br /> 500-1000 ' <br /> Hardcover Varia e Requ' red: Y s No Date of C uncil ApprovaJ.: <br /> Grading: Staff pproval ate: By: Coun ' 1 Approva� Date: <br /> Septic: Staf f A proval. Da e: BY� <br /> Zoning File:# R sol ti n # Reso ution Date: <br /> REMARKS (in ho e) : , <br />