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T ♦ � <br /> CHECK OFF LIST FOR ISSUAtvCE OF PERcti,fITS <br /> FOR OFFICE USE ONL Y � <br /> ADDRESS OR LEGAL: t35`l ��s'�- Aow-r' C��� <br /> PID: <br /> DESCRIPTIONOF Yf/ORK: p�c.l,c (RR.ev�s�o Cp�r�u r--.� �w��-# PO��y <br /> ------------------------------------------------------------------------------------------ <br /> ZOtVI�YG REVIE tV B X: AATE APPROVED: /-?� -o S � <br /> B UILDING REV.FEW B I', DATEAPPROVED: �-�-�� <br /> -------------------------------- <br /> FEES TO BE CHARGED: tL�Iisc. Fees Calciclated By: <br /> PERI�IIT Yes ✓ No <br /> PLAtV RET/IEYV Yes t/ t�lo SEYVER GO�VNECTION <br /> ST.�.TE SURCH.4RGE Yes ✓ tVo tiVATER COt tWECTl01V <br /> ItVVESTIG 4 TION FEE Yes No PARK FEE <br /> St!C .Yes No SITE INSPECTIO�V <br /> Number of SAC U�tits OTHER (specify) " <br /> -------------------------------------------------------------------------------------------------------- <br /> 2'ONIIYG CHECh'LIST Zoriiitg Dish•ict: <br /> Fire Deparhne�rt: Post O�ce: Sclioo!Dish•ict: _.. <br /> Lot Area: Sq.ft. ficres 6YidtlT Deptli <br /> Sac�vey Subrnitted: Yes_� No Date af Scuvey: <br /> Proposed Setbncks: <br /> F�re,cu(La�e): 9'd � 1' Right Side: 7 5� <br /> Rem•(Sh•eet): /'�� � Left Side: ?�o` <br /> Adjacent Structu�•es: Rr'rAc H� ��etlnnd: iV/A <br /> Buifding Height: Def. Hgt. r✓�A Peak Kgt. — <br /> LotCovernge: � 13•N <br /> Grading: Stnff.4pp►'ova!Date: '— By: Cot�nci!Approva!Date: <br /> Septic: Stnff Approval DRIe: BY� <br /> Zonirtg File: #oy-30�7 Resofution: # Resolcition Dnte: /I- ZZ-o�( <br /> Shorelancl Disd•ict: ve5 <br /> ,4vg.Setback: o_�c _ BlufjrSet6ack: LotCoverage: <br /> Existing Proposecf <br /> Hnrdcove�•: 0-7�' <br /> 75-250' YN.9� 29�!!�', <br /> 250-500' _T— <br /> 500-!000' ! <br /> H'ardcover Variance Reqccired: Yes�_ No Date of Cauncil'�lpproval: I-Zz�o <br /> REMARKS(in house): ; <br /> � <br /> 31 <br /> - �i ii , ji 7c ri . . . ' �d� �Ili�': 4, ���j ��d �hs �•�' �� �� � s`u�Y �a�; 'f�'t�� <br />