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� CHECK OFF LIST FOR ISSIIANCE OF PERMITS <br /> FOR OF�ICE USE ONLY <br /> ADDRESS OR LEGAL: � 3 C�l_� ��•��• L �rv r!J�`l PID: <br /> DESCRIPTION OF WORR: � ( I-f-f�,C=�; �C=�`t�`�L��' �"��'=�=-'`� <br /> ---------- --------------------------_---����-- <br /> ZONING REVIEW BY: � �/ln�` DATE APPROVED l f� <br /> BIIILDING_REVIEW-BY---- �-�-(�--�-��---------DAZ'S APPROVED----(O �e-f3 ------------- <br /> ----- -��_ �---- <br /> FEES TO BE CHARGED: 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� PARK FEE <br /> SAC Yes No�� SITE INSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ---------------------------- --- <br /> ZONING CHECR LIST Zoning District: C_�- I�'=� <br /> Fire Department: �'Vt,�;��� Post Office: ��� School District: ���c�%«�� <br /> � �3 �`�`� <br /> Lot Area: `'V�% <7l'�?'���h_ Depth: <br /> Survey Submitted: Yes� No Date of Survey: � c�� �r�: <br /> Proposed Setbacks: � <br /> Front (�trl�el: `7S Right Side: �5 <br /> Rear (Street) : /✓`/9' Left Side: /��/} L% <br /> Adjacent Structures: �T��� Wetland: ��r4 <br /> Building Height: Def. Hgt. �• � Peak Hgt. <br /> Avg. Setback: ��/ (!'� Lot Coverage: `7 �`` <br /> Existing Proposed <br /> Hardcover: 0-75 ' <br /> 75-250 ' <br /> 250-500 ' <br /> 500-1000 ' ��•Z� � <br /> Hardcover Variance Required: Yes No� Date of Council Approval: <br /> Grading: Staff Approval Date: �J`✓ ( (� By: Council Approval. Date: <br /> Septic: Staff Approval Date: N (� By: <br /> Zoning File:# l� ,_ esolution # : Resolution Date: <br /> REMARKS (in house) : _ <br />