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' � CHECk OFF LIST�CE USE ONLYO� PER�IITS <br /> FOR 0 <br /> �DDRESS OFti.EG:�i..: i390 �?,�5'T Po�^�T �PID: <br /> Di TGd� t u�vo v� �rr�4c�SFP� � <br /> DESCRIP'IZOti OF �j'ORI�: Ar�►� �� <br /> ZO\�G RE`�v BY: DATE APPROVED: 3_� ..c�6 <br /> BLZI.DL\G REti�tiV BY: DATE �iPPROV�D: -s3�'c 6 - <br /> FEES TO BE CIi-�RGED• l�lisc. Fe�s Caiculated By: <br /> PERtifIT • Yz5 � �o — <br /> PL:�N REVIE� Yes �/' No SEtiVER CONNECITON <br /> .� No WATER CO�Wi ECTTON <br /> STATE S li RCH.�RGE Yz5 — p n� �E <br /> I�i VESTIG:�TIO V FEE Yes vO <br /> SAC -'i'es No STTE INSPEC"IZON <br /> Number of S�.0 Units OTHF1t (specify) <br /> ZO\Z\G CHECI� LIST Zonin�Discrict: L� '�a Shore!aad District: ��s <br /> � 'Post O�c�: �/►�w-•.A School District: •l'l��s� <br /> Fire Depar�menr. yvw �-c9 <br /> Lot a.rea: Sq.ft. q, <br /> 7°r 2 Acres .22 Wiach (o S � Dep�h /5� <br /> Survey Submi�ced: Yes /�" <br /> ;�io Da[e of Survey: � -�9'1"�� " �� <br /> 6 R��,,�- r�,�,,,,�7 �"- b.�►• . �•�• <br /> Proposed Secbacks: ,,4 d ' Rignc Side: N�� (� y <br /> �s�c (Lal:e): <br /> g�es��(Screec): 2'o � y y I.efr Side: 22 N�I4 <br /> Adjacent Struccura: �17�u`� Weciand: N l/J� <br /> Building Height: Def. Hgt. C,. l� Peak H�c• E n. I� <br /> Avg. Secbacic: <br /> �. � Bluff Setback: N(�- L.ot Coverage: ��'� <br /> Exisrin� Pronosed <br /> 1 I�°I <br /> f�ardcover: 0-75' �— S�,S- �N _p-v rt R..0 <br /> 75-?50' Y�'Z �' V.�' . <br /> ?�0-�00' <br /> �00-1000' <br /> Hardcover Variance Required: Yes �_ N° Daze of Council Anoroval: 1 I'r 3 -�T.S , <br /> Gcading: Scaff App�val Dace: -- By: Couneil �pproval Dace• � <br /> ^ By• -- <br /> Sepcic: Staii �pproval Dace: <br /> j o g� Raoiucioa: � ���_ b <br /> Resolucioa Daze: � �' �3`�� <br /> Zonins File: T Z <br /> RF�tiIA.RKS (in hOuse): <br /> � � 26 <br />