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AL CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 62$'$ 0(,10 CfMS17+L &4f.4 PID: <br /> DESCRIPTION OF WORK: <br /> ------------------------------------------------------------------------------- <br /> ZONING REVIEW BY: 1V 1A DATE APPROVED: <br /> BUILDING REVIEW BY: ck4lvw..` DATE APPROVED: (., - 30 -ci3 <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes c- � No <br /> PLAN REVIEW Yes-7;7 -No SEWER CONNECTION <br /> STATE SURCHARGE Yeses No WATER CONNECTION <br /> INVESTIGATION FEE Yes No i,� PARK FEE <br /> SAC Yes No ✓ SITE INSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ------------------------------------------------------------------------------- <br /> ZONING CHECK LIST Zo ing District: <br /> Fire Dep rtment: Pos Offic : School ' strict: <br /> Lot Area: Widt Depth: <br /> Survey ubm'tted: Yes No Date of Survey: <br /> Propose Set acks: <br /> Fr nt (L ke) : Right Side: <br /> Re r (Str et) : Left ide: <br /> Ad 'acent S ructures: Wetland: <br /> Buildi Height: Def. Hgt. Peak gt. <br /> Avg. S tback: Dot Coverag <br /> Existing Proposed <br /> Hardcov r: 0--75 ' <br /> 75-250 ' <br /> 250-500 ' <br /> 00-1000 ' <br /> Hardcov r Variance Req ' red: Yes No ate of Council Approv <br /> Grading Staff Approval ate: By: Council Approval D te: <br /> Septic: Staff Approval D te: y: <br /> Zoning ile: # s lution # Resolution Date: <br /> REMARKS (in house) : <br />