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, �CHE�� OFF i�TST FOR ISSU.ANCE 4F �ERMITS <br /> F�R OFFICE USE ONLY� . . <br /> ApDRESS ORLEGAL: ZgZ.v sd�nn��2s� c.r�.N ` <br /> PID: <br /> I7ESCRIPTIO� OF W4RK: Q A� R�uon�. 12�-�✓� =�_— ------------------- <br /> � ������ ��� ���������������� <br /> �....��������..����..��..�..����������1..'�� <br /> ZO�TG REVIT�V BY: ---- � tq DATE APPROVED: <br /> gUILDI[�IG REVITtiY 8Y: . . DA.TE APPROVED; Z-2f� <br /> � -=-- ----- _...__ ---=----------------------------------------------��---- <br /> �'EES TO BE CHARGED: Misc, Fees Calculated By: <br /> PERMIT Yes _� No <br /> PLAN REV�EtiV � Yes No � �VA,�O���ON <br /> STATE SURCHARGE Yes � No <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes Na SITEINSFECTION <br /> Number of SAC•Units OTHER (specify) <br /> ZON.i�i TCr CH�CK LIST Zoning District: N d c H�"16 e- .. <br /> Fire Department: Post.Office: School Dis[rict: � ' <br /> Lot Area: Sq.ft. Acres ' Widch Depttii <br /> Survey Submitted:� Yes No Date oE Survey: <br /> Proposed Setbacks; • � <br /> Froat(Lake}; Right Side: <br /> Rear(Street): Laft Side: <br /> Adjaceot Structures: Wettan : <br /> Buil�lin;Hei�t: Def. Hgt. Pea.�: gC. _ <br /> Lot Covera�e: <br /> Gradino: Scaff Approvai Date: B : �Council Approval Date: ' <br /> Szptic: S�af� Approval Date: � � <br /> ZQain� File: R Resolutioa: n P.esotution Date: <br /> Shorelar!d District: �t Coverge: <br /> Avg. Setback: Blu;f Setbac ' <br /> Eus�ing Proposed <br /> F-Izdcover: 0-75' <br /> 75-250' <br /> 2�0-SCuJ' <br /> . �oo-icc�� <br /> �i��.C.rJt�: ti�:2,C' f:�^yL'!: ; 5 , t'1� _ nf('r�,:inf�� A,n�r�'v,�: ---._� <br /> ec: z <br /> F.E�L�S (in hou�e): <br />