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� CHECR OFF LIST FOR ISSDANCE OF P$RMITS <br /> FOR OFFICE USE ONLY <br /> ADDR$SS OR LEGAL: l /U6/� �Q/� l�-c�� PID: a`I' /�� s:�3 `�� C'C�' (� <br /> DESCRIPTION OF WORR: CCZr,�,q�. LC.c��G�C�� <br /> -------------------�--��----------------------_--�^-�_--`-------------- <br /> ZONING REVIEW BY: DATE APPROVED � _ <br /> BIIILDING REVIEW BY: �t�-�. DATE APPROVED: "$- ( -ci � <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes��d //No - <br /> PLAN REVIEW Yes�o SEWER CONNECTION <br /> STATE SURCHARGE Yes No WATER CONNECTION <br /> INVESTIGATION FEE Yes No �/ PARK FEE <br /> SAC Yes No Y SITE INSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ------------------------------------------------------------------------------ <br /> ZONING CHECR LIST Zoning District: �jr/�C. <br /> Fire Department: (t� Post Office: /v C School District: ��� <br /> Lot Area: /(��L Width: /(�l �-- Depth: L <br /> Survey Submitted: Yes� No Date of Survey: .3- 7 - 8 � <br /> Proposed Setbacks: <br /> Front (-�ake�l : (Z b �t Right Side:_N �} <br /> Rear ( �-z���.) : 3S� '� Left Side: �6� <br /> Adjacent Structures : /�T7'w-��-Fe� Wetland: /(/f/{ <br /> Building Height: Def. Hgt. N�i�- Peak Hgt. ,�//� <br /> Avg. Setback: /t/�/} Lot Coverage: i✓�I�- <br /> Existing Proposed <br /> N?r�CO��aY': �-.15 � <br /> 75-250 ' <br /> 250-500 ' <br /> 500-1000 ' <br /> Hardcover Variance R quired: Yes No Dat of Cou cil Approval: <br /> Grading: Staff App val Date: y: pproval Date: <br /> Septic: Staff Ap oval Date: By• <br /> Zoning File:# Resolut n #: Resolut 'on Date: <br /> REMARRS (in h use) : <br />