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� _ <br /> CHECR OFF LIST FOR ISSIIANCE OF PSRMITS <br /> , FOR OFFICE USE ONLY <br /> ADDR$SS OR LEGAL: _��OSU � ;l1>/1�5;�/'1 ,�r✓�. � PID: �7 � ��7" 2 -�> �� �?4�'.-r� <br /> DESCRIPTION OF WORR: �(/U//d'�C�►''-A�� � � ' 2� <br /> --------------------f�r��-_--, � ------------------------_-----�----`------------- <br /> ZONING REVIEW BY: ✓/�%��'-- DATE APPROVED � �� �� <br /> BIIII�DING REVIEW BY: DATE APPROVED: �d -�(� '�2d <br /> ---------------------- ------------------------------------------ <br /> �-----------� <br /> F$ES TO BE CHARG$D: Misc. Fees Calculated By: l/ "�� �' <br /> .�. .._:� <br /> PERMIT Yes No <br /> PLAN REVIEW Yes No SEWER CONNECTION -- (�D <br /> STATE SURCHARGE Yes� No�.,,l WATER CONNECTION - <<•' • <br /> � �.T ICtATION FEE Yes No ,/ PARK FEE - ' �'�'�-- <br /> � SA�C T�`�J ',���• � °� Yes�_ No SITE INSPECTION <br /> --Number of SAC Units �_ OTHER (specify) --- <br /> ------------------------------------------------------------------------ <br /> ZONING CHECR LIST Zoning District: �1�� t� � � <br /> Fire Department•��`''���.��`�� �� Post Office: ���'M��- jchool District: �'�'��TM�� <br /> Lot Area: � �(�'� � " Width: � t✓' r Depth: ���` 3 �;-.1 c-� <br /> Survey Submitted: Yes� No Date of Survey: 7-/fl��9 ' �_9� <br /> Proposed Setbacks : r �..- r <br /> Front �� �n �C�. Right Side : ��.. � = <br /> Rear (-9�r2�t�) : �J�1 } Left Side: /�i'T� '' �°'�"�"� <br /> Adjacent Structures :�'�'7-� f'�:"'� Wetland: � <br /> y � �.� � <br /> Building Height: Def. Hgt. �� Peak Hgt. �:'..�`"' <br /> �--�-� C '!,- - �'E�'` �?�.�''r�:J_1-,. ?C . <br /> Avg. Setback: Lot Coverage: ..> _ <br /> Existing Proposed <br /> Hardcover : 0-75 ' � <br /> P <br /> 75-250 ' <-' '�' ,..-�`�. <br /> �::� � <br /> 250-500 ' �� ��I p <br /> !_ �� <br /> 500-1000 ' � <br /> Hardcover Variance Required: Yes No � Date of Council Approval: <br /> � <br /> Grading: Staff Approval Date: �• ` .�t°~? By: ��.. Council Approval Date: --� <br /> Septic: Staff Approval Date: '' By� 'p"� <br /> Zoning File : tt "�' Resolution #: "�""" � Resolution Date: <br /> REMARKS (in house) : ! <br /> i <br /> - ,� <br /> <,K . �. /`/Z�y< 1 S'll��'? .', {�;��-� �'E�lce,--�;��.,n�l � <br /> Lo,- C��,��"c�t�t. 2�,s xN�a,s°' + Is.S rzo _ 2 _ r . <br /> b ��" '": p "' "�.°�,:" C` � <br /> .,. �. <br />