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s.• CHECR OFF LIST FOR ISSIIANCE OF PERMITS <br /> . <br /> ` `' FOR OFFICE USE ONLY <br /> ADDRESS OR LSGAL: ZS� Ca4�lr/�(�A�¢.1� �2 PID: <br /> D$SC,RIPTIOI�I OF WORR: (�C t�J (Zlr�S <br /> ------------------------------------ <br /> ------------------------- ----------------- � - <br /> ZONING REVIEW BY: DAT$ APPROVSD. � �- g Y <br /> BIIILDING REVI�FT BY: DATS APPROVED: K ` �- �Y <br /> F�S TO BE CHARG�: Misc. Fees Calculated By: <br /> PERMIT Yes �No <br /> PLAN REVIEW Yes � No SEWER CONNECTION <br /> STATE SURCHARGE Yes � No WATER CONNECTION <br /> INVESTIGATION FEE Yes No !� PARR FEE <br /> SAC Yes No v SITE INSPECTION <br /> Number of SAC Units _�_ OTHER (specify) <br /> ------------------------------------------------------------------------------ <br /> ZONING CHECR LIST Zoning District: G2-/� <br /> Fire Department: (,�nrc, (,A(c� Post Office: ,�, (a4�t�c.JSchool District: �,(22.pM0 <br /> Lot Area: 8�,oo d ''= Width:J��,�,�(�� Depth: �6c�c,�4�R, <br /> Survey Submitted: Yes� No Date of Survey: 3-�g-S�{ <br /> Proposed Setbacks: <br /> Front (I�nke) : t�• Ff� Right Side: 7Z�y�'F <br /> Rear (Str�€'t) : �3. � � Lef t Side: ��� <br /> Adjacent structures: /1/ /� wetland: /3�l• S� <br /> Bui�ding Height: Def. Hgt. 1°1 Peak Hgt. 2 7 <br /> Avg. Setback: ��f�- Lot Coverage: /U/i5� <br /> Existing Proposed <br /> Hardcover: 0-75 ' <br /> 75-250 ' (� `o <br /> 250-500 ' <br /> 500-1000 ' <br /> Hardcover Variance Required: Yes No� Date of Council Approval: <br /> Grading: Staff Appr al Date: y: C uncil Approval Date: <br /> Septic: Staff Appro a Date: By: <br /> Zoning Fi�e:# Res ution #: R solution Date: <br /> R$MARRS (in honse) <br />