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~ CHECR OFF LIST FOR ISSIIANCE OF PERMITS <br /> ' ' FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 3�(oS /'lTOR'l'l-} Sl�kOl� � 2 PID: �'rI - // �" � 3 �.,.Z ��O �' <br /> DESCRIPTION OF WORK: ��2�'�� �«� <br /> --------------------- <br /> -------------------------------------- <br /> ZONING REVIEW BY' DATE APPROVED: S�'�"�1j <br /> BIIILDING REVIEW BY: DATE APPROVED: �`" ���� <br /> ------------------------- <br /> FEES TO BE CHARGED� Misc. Fees Calculated By: <br /> PERMIT Yes � No <br /> PLAN REVIEW Yes�No�� WA�R CONNECTION <br /> STATE SURCHARGE Yes No <br /> INVESTIGATION FEE Yes No_�� PARK FEE <br /> SAC Yes No �/ SITE INSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ------------------------------------------ <br /> ------------------- <br /> ZONING CHECR LIST Zoning District: L�-�� <br /> Fire Department: un.� Post Office: N School. District: /ll,ndr•f� <br /> Lot Area: �� «-f�'r'�'`�G�' Width: Depth: <br /> Survey Submitted: Yes�_ No Date of Survey: 7'" Z �' g� <br /> � �ri� r=<<-� <br /> Proposed Setbacks: i ,f., <br /> Front (�3�) : 6Z �� Right Side: �3S' � <br /> Rear (Street) : fa� �'� Lef t Side: (S.S J � <br /> Adjacent Structures: Z� � 'i' Wetland: <br /> � � Peak Hgt. /'�/ <br /> Bui].ding Height: Def . Hgt. ��z <br /> Avg. Setback: /�/ � _ Lot Coverage: <br /> Existing Proposed <br /> Hardcover: 0-75 ' <br /> 75-250 ' <br /> 250-500 ' ��C <br /> 500-1000 ' <br /> Hardcover Variance Re i ed: Yes Date ouncil Approval:_ <br /> Grading: Staff Appro aI. Date: Co ncil Approval Date: <br /> Septic: Staff Appr val Date: <br /> Zoning File: # Res ution Resolution Date: <br /> REMARRS (in ho se) : <br />