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Alt • • CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 76S- U LID Corby S7 ek_ (3# PID: <br /> DESCRIPTION OF WORK: Con,se s5r o„) S-rw. O <br /> ZONING REVIEW BY: ' 0 Mn4"-- DATE APPROVED: a-(o -9 c( <br /> BUILDING REVIEW BY: ll QA.H - DATE APPROVED: 6 -4(1 <br /> FEES TO BE CHARGED: .{� Misc. Fees Calculated By: <br /> PERMIT Yes I/- No <br /> PLAN REVIEW Yes c No SEWER CONNECTION <br /> STATE SURCHARGE Yes ✓ No WATER CONNECTION <br /> INVESTIGATION FEE Yes No L------ PARK FEE <br /> SAC Yes No SITE INSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECK LIST Zoning District: /Z2'(4 <br /> Fire Department: ost O ice S h of irstrict: <br /> � <br /> Lot Area: �e dth: Ph <br /> Survey Submitted: Yes oC No Date of Survey: 00 r"it..E <br /> Proposed Setbacks : <br /> Front (kake) : 12 t t Right Side: /51) r + (0 <br /> Rear ( t. : 9? ' t- Left Side: A/01- 6) <br /> Adjacent Structures: 500 <br /> 14-+ Wetland: N /A <br /> Building Height: Def . Hgt. (, .t- Peak Hgt. -- <br /> Avg. <br /> Avg. Setback: &1 (4 Lot Coverage: it//n <br /> Existing Proposed <br /> Hardcover: 0-75 ' <br /> 75-250 ' N-J (fi <br /> 250-500 ' <br /> 500-1000 ' ;\/) <br /> Hardcover Variance Required: Yes No I Date of Council Approval : _m ____ <br /> Grading: Staff Approval Date: // 04 By: Council Approval Date: <br /> Septic: Staff Approval Date: (/1PBy: <br /> Zoning File: # Iy(O Resolution # : 34(l Resolution Date: 4, •3-etc( <br /> REMARKS (in house) : <br />