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�CHTCK Ok'F i.IST FOR ISSUANCE O�' i'E�'�IITS <br /> FOR OFFICE USE ONLY� � <br /> ADDRESS aR LEtrAL: 13� c5 �A�(�cd1� � � <br /> PID: <br /> 77ESCRL�P'I�IO�T OF wORK: 2 e s �'h`'`'` ��"' s��' <br /> --- - --- ----------- Q.r _J'Ce!'��II}ts�--- --�-`L� bt�'(---'� --�tcK���. <br /> ZOYI�i TG REVIEtiV BY: e.k DATE APP�OVED: L'3 . °1t(� Sl�td <br /> �U1I�DING REVLE�V SY. ,� � , DATE APrROVED; ��z3-a� <br /> FEES TO BE C�-7A.�.GED: Misc. Fezs Calculated By: <br /> p��yuT Yes ,l No <br /> PLAN REVZEtiY � Yes �/ No SE��TER CO�tNEC`I`ION <br /> STATE SURCHAR.GE Yes �/ No tiVATERCONNECTION <br /> INVESTIGATION FEE Yes No � PARK. FEE <br /> SAC Yes No _� SITETNSPECTTON _ <br /> Number of SAC�Units OTHER (specify) <br /> ---------------------------------------------- <br /> �pYi��tG� CTI�CK LIST Zoaiag Districc: (�.� —� {� . <br /> Fire Deparcment: Post Office; School District: � <br /> L,ac Area: Sq.ft. �Z 1 ��Acces Widch l�lJ� ��J DeP� I ��.�--�— <br /> Survey Submitted: Yes �� Irfo Date of Survey: � �`p�Q�i <br /> �roposed Setbacks: �e}� h� . : <br /> '� Front(L�e}+:• 32 -&�Side; <br /> � Re ar(.5��: �f�• � 7 ���e�€t S ide: I�•7 2- / <br /> �dja�P�r S�nirhlrc5; �'1/�` _ �Varl2nd: VL � <br /> BuildinJ Hei�it: DeE. Hgt. Peal:Hgt. <br /> o �Nu�ct (�8�S� ha,se. 17 F3� <br /> Lot Covecage: ��' �� hWS� <br /> GradLn�: Scaff Approval Date: By: Council_ Approval Date: ' <br /> Septic: Staff Appro�ia�. Date: � �Y� � <br /> Resolu�ion Date: � Z� O S�"b�et� <br /> �' Zoai.n� File: � �7'3Z�oq Resotutioa: n v�tnree,t.� <br /> Shorzland District: ✓ <br /> Av�. Setbac'�:: �/J�- B!�f�SetSack: L.o!Cove2�e: <br /> ��5��a Propased <br /> Hzecover: G-7�' �p' �p <br /> 7�-250' __`�� h/� �1�'1 <br /> z,o-���� 7•!o a !9• lw��+ sk�d� <br /> �co-:c�^�� ��/� <br /> _�?�{_,,__f�% <br /> i-r?-CCO`;2' � Z'._.�2 `'�L".:2��: �i 2i ��� ✓ �=-_ C- �.v'"_�:. n�_"-. �. <br /> �.��L�:-�`+ fLn ho'��): <br />