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� • - CggCg pgg ZIST FOR ISSIIANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRES S OR LEGAL: �� ��2���� CN PID: . <br /> �n� , �.¢ � VW°Ncx,rc.�5 - G�4I� S�/2 S <br /> DBSCRIPTION OF WORK: �4�''r ------------ <br /> --------------------- -- �="'c�S <br /> - - DAT`E APPROVED: ' - <br /> ZONING REVIEW BY: - _ . . <br /> DATS APPROVED: C� ' Z-=Qi S <br /> BIIII,DING REVIEW BY: — ------------------------------- <br /> -------------------- <br /> -- --------------- <br /> FEES TO BE CHARGED: Misc. Fees Ca].culated By: <br /> PERMIT Yes �'No <br /> PLAN REVIEW Yes �/' Na SEWER CONNECTION <br /> WATER CONNECTION <br /> STATE SURCHARGE YeS �NO pp,RK FEE <br /> INVESTIGATION FEE Yes � No v` gITE INSPECTION <br /> SAC YeS OTHER (specify) <br /> Number of SAC Units -------------------------- <br /> -------- <br /> ---------- <br /> District: �2 '�� <br /> ZONING CHECR LIST Zoning <br /> Fire Department: <br /> nJ �G Post Office: � School District: <br /> �-- <br /> Lot Area: <br /> � Width: Depth: <br /> Survey Submitted: Yes�_ <br /> No Date of Survey: � 2-' � " �� <br /> Fr N'KUWc1 r�t�ow�w+--#f <br /> Proposed Setbacks: j � Right Side: G-�r'�' <br /> Front (�Q� = ! <br /> � + <br /> Rear (��% = N (� Lef t Side: ( �S <br /> Adjacent Structures: 3�? <br /> ' � Wetland: �'✓�i4 <br /> Building <br /> Height: Def. Hgt. N�� Peak Hgt• � <br /> -�- Lot Coverage: "'""'" <br /> Av:g. Setback: proposed <br /> . . E�isting� a .. <br /> Hardcover: 0-75 ' <br /> , N° G(�(���`r^�,5 <br /> 75-250 <br /> 250-500 ' <br /> �� � Y <br /> 500-1000 ' <br /> Hardcover Variance Required: Yes No,� <br /> Date of Council Approval: <br /> Grading: Staff Approva� te: <br /> Council Approval Date: <br /> Septic: Staff Approval. te: y� <br /> Zoning Fil.e:� <br /> Re lut o Resolution Date: <br /> gEMARKS (in house) : . <br />