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CHECX OFF LIST FOR ISSIIANCE OF PERMITS <br /> . FOR OFFICE USE ONLY <br /> � <br /> _�DDRESS OR LEGAI,: � I� C.���F 5 T PID: ' Lf-/r' , _ . � i-_ �C c <br /> � <br /> �BSCRIPTION OF WORR: Jv C�� � S <br /> ---------- ----------------------------------3=�-�J--------------- <br /> ZONING REVIEW BY: (�� lVtnt�-- _ DATE APPROV$D: '� ' } <br /> '3IIILDING RE�7IEW BY: �O C��--- DATS APPROV�: � ' �-�/ <br /> -------------------- - <br /> g�g Tp gg C��• Misc. Fees Calculated By: <br /> PrRMIT Yes � No . <br /> PLAN REVIEW Yes � No SEWER CONNECTION <br /> �TATE SURCHARGE Yes �% No WATER CONNECTION <br /> �:�1ES�IGATION FEE Yes No �- PARR FEE <br /> ;�C ' Yes ✓' No SITE INSPECTION <br /> ;Jumber of SAC Units � OTHER (specify) <br /> --------------------------------------------- <br /> .ONING CHECR LIST Z oning Di stri ct: t22-� a <br /> _�'ire Department• (,c�ti� (,w�C� Post Office: (�„�.r, SchooJ. District: Q2p�vo <br /> Lot Area: �o,3�O s� �r •b`I �ucc�Width: ( �p Depth: Z�5�S A�vi <br /> �urvey Submitted: Yes o� No Date of Survey: S� f`r-S 3 <br /> Proposed Setbacks: , , <br /> Front (�) : �1b Right Side: � 2c� <br /> Rear (S�) : !lD � t Left Side: 7� �� � <br /> Adjacent Structures: /�/�/� Wetland: G7 � P(�-c-rcc--rC�O T����T►��'e-y <br /> I <br /> Buil.ding Height: Def. Hgt. ��• s Peak Hgt. (�. s <br /> ?vg. Setback: � • �L Lot Coverage: NIr� <br /> Existing Proposed <br /> rardcover: 0-75 ' /. 7�o <br /> 75-250 ' 3b•3� �� <br /> 250-500 ' <br /> 500-1000 ' <br /> Hardcover Variance Required: Yes_ C� NoJ Date of Council Approval: 3-2�-53 <br /> Grading: Staff Approval. Date: [� - 3'S 3 By:`����CounciJ. Approval Date: — <br /> Septic: Staff Approval Date: N�� By: <br /> Zoning Fil.e:� /7�12 Resolution #: 32s3 Resolution Date: �-'Z� -5.3 <br /> RF�SARRS (in house) : <br />