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CHECR OFF LIST FOR ISSIIANCE OF PF�RMITS <br /> FOR UFFIC� USE ONLY <br /> ADDRY�SS OR LEGAL: ��(�-G �( �`L��� (,�/z-y�-v ��,��t PID: <'' � " // '� - ,� .3 �/ �' �c y <br /> DESCRIPTION OF WORR: �-�'Ji-C�z�.i,.7-e� ✓ �` � <br /> _ -' <br /> ------------------�j - - ---l-�--------------------=--5_--'-Z--------------4 <br /> ZONING REVIEW BY:C�' � tsP C(�Pc,�vv�(ATE APPROVED l£j 5 <br /> BQILDING REVIEW BY: DATE APPROVED: S�/fS`S �- <br /> FEES TO BE CHARGED: Misc. Fees Ca�culated 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: L.�Q - �� <br /> Fire Department• V✓lp��✓� Post Office: /1.��� Schoo� District: /1/�� <br /> Lot Area: Z A C -f Width: �Fl���= Depth: ,sdt�` '� <br /> Survey Submitted: Yes I/ No Date of Survey: /- S-� � <br /> Proposed Setbacks : � <br />.�.► Front (��) : /U ��4 Right Side: IOc� -� <br /> Rear (�'�) : l SD'-r Lef t Side: 30' <br /> Adjacent Structures: 1t3 ' Wetland: <br /> Building Height: Def . Hgt. ���4 Peak Hgt. <br /> Avg. Setback: Lot Cov age: <br /> Exi • ing Propo ed <br /> Hardcover: 0-75 ' <br /> 75-250 ' <br /> 250-500 ' � <br /> ; <br /> 500-1000 ' '� � <br /> � <br /> Hardcover Variance equi ed: Y No� Date of Cou cil Approval:_ <br /> � <br /> Grading: Staf f App oval D te: �� ,��By:� Counci]� Approval. Date: <br /> �' <br /> Septic: Staff App ova]. Da e: By: <br /> Zoning File:# eso tion #: Resol tion Date: <br /> REMARKS (in hou e) : <br /> F <br /> , + <br /> ; ( <br /> ;` <br /> � <br />