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.� _ : CHECK OFF I,IST FOR ISSIIANCE OF PERMITS <br /> FOR OFFICE USE ONI,Y <br /> ADDRESS OR LEGAZ: �ZtO /�j�/�Vi4�Qt`: C�9NL PID: � �� : <br />?JESCRIPTION OF WORR: �N�� <br /> _------------------- ---- ----------------- <br /> ZONING REVIEW BY: DATE APPROVSD: c^ j-�� - - <br /> _ _ <br /> 3IIILDING REVISW BY: DATS APPROVED: S"� 3'`4 `S .. : <br /> --------------------- -- <br /> gggg g•p Bg �R�: Misc. Fees Calculated By: <br /> PERMI T Ye s L/No ' � � <br /> PLAN REVIEW Yes � No SEWER CONNECTION <br /> STATE SIIRCHARGE Yes ✓No WATER CONNECTION <br /> INVESTIGATION FEE Yes No ✓ PARR FEE - <br /> SAC � Yes Na � SITE INSPECTION � <br /> Number of SAC IInits OTHER (specify) <br />-------------------------------------------- , . � - C <br /> ZONING CHECR LIST Zons.ng District• /L ( <br /> Fire Department: Post f i e: ho istrict: <br /> Lot Area: idth. ep h: <br /> Survey Submitted: Yes� No Date of Survey: �-2h "�'7 3 <br /> Proposed Setbacks: /,, � � i <br /> Front (I�rak'e) : /��/�t Right Side: S'7 <br /> Rear (S�r�et) : �� Lef t Side: �o�� � <br /> Adjacent Structures: �O <br /> ` Wetland: � <br /> � <br /> Building Height: Def. Hg Peak gt. <br /> Avg. Setback: L Coverag : <br /> Exis in Proposed <br /> Hardcover: 0-75 ` <br /> 75-250 ' <br /> 250-500 ' <br /> �---- <br /> 500-1000 ' <br /> Hardcover Varianc Require : es No Date o Council Ap roval: <br /> Grading: Staff proval D e: y: Council. Appro aI. Date:_ <br /> Septic: Staff pproval Da e: BY: <br /> Zoning File: Re olution #. Resol.ution ate: <br /> REMARKS (in onse) : <br />