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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL s x -- :I0 / Octi— " sP - "PID - - _ .._. _-_ _._.. <br /> DESCRIPTION OF WORK: C9 ' J(N( <br /> _ JC:L�-- .,.. - DATE - - <br /> ZONING REVIEW BY: - APPROVED: - <br /> ������� <br /> BUILDING REVIEW BY: IV - DATE APPROVED: - <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> 6_-_)(2-44Ot p i -7c ,00 -E ENGfN-e-e,2 <br /> PERMIT Yes No 11/15 (1-441PLAN 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 /> ZONING CHECK LI T Zoning District: <br /> Fire Department <br /> Post Office: \,, School �st' ict: <br /> Lot Area: , Width: Depth: <br /> Survey Submitt=d: Yes No1_ Date of S rvey: <br /> Proposed Setba ks: <br /> Front (La e) : \ Right Si•e: <br /> Rear (St eet) : Left Sid: : <br /> Adjacent Structures: Wetland <br /> Building Heig t: Def Hgt Peak-'Hgt. <br /> I <br /> Avg. Setback: Lo Coverage: <br /> Ex sti g *roposed� <br /> Hardcover: 0 75 ' / <br /> 1 <br /> 75- 50 ' <br /> 250-•00 ' <br /> 500-1.00 ' <br /> Hardcover Valiance Required: Yes N. Date of Council Approval: <br /> Grading: St-ff Approval Date: By: Council Approval Date: <br /> Septic: Sta f Approval Dae: By:� <br /> Zoning File:# esolution #: II Resolution Date: <br /> REMARKS (in house) : If \ <br /> . , . <br /> _,. . . _ . <br />