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- • CHECK OFF LIST FOR ISSIIANCE OF PERMITS <br /> ' FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: ��'o� NG �'�' PID: <br /> DESCRIPTION OF WORR: C9�12AC�C� � ��'�C'�G Q <br /> ZONING REVIEW BY:--- - --------------DATE APPROVED:-- 5"�J '��1 --------------- <br /> BIIII,DING REVIEW BY: � DATE APPROVED: s-rr-4y <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 /> ----------------------------�`l�-- <br /> ZONING CHECR LIST Zoning District: <br /> Fire Department: �J+�c� Post Office: ��v��^� School. District: t�57��� <br /> Lot Area: i�.y�s3 su -�T" Width: ��O Depth: j �1 �1• �3 � <br /> Survey Submitted: Yes o� No Date of SurvPy: 3 'ZZ-5�'1 <br /> Proposed Setbacks : � r � <br /> Front �� : � = Right Side: � � <br /> Rear ("�F�-) : ��t' Left Side: / 2 r � <br /> � <br /> Adjacent Structures : 1 � Wetland: N �" <br /> Building Height: Def. Hgt. 0 •�`- Peak Hgt. D •K <br /> Avg. Setback: /l��/�- Lot Coverage: �✓��" <br /> Existing Proposed <br /> Hardcover: 0-75 ' <br /> 75-250 ' <br /> 250-500 ' <br /> 5oo-i000 � Z3 z6.g�7v <br /> Hardcover Variance Required: Yes No v� Date Council Approva�: _. <br /> Grading: Staff Approv Date: y: ouncil Approval Date: <br /> Septic: Staff Approv ]. Date: BY= <br /> Zoning File: # Res ution ResoI.ution Date: <br /> _---- <br /> REMARRS (in house : ,. <br />