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f . � , <br /> CHECK OFF LIST FOR ISSUAIVCE OF PERttiIITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR L�'GAL: 3y S S PR�iV 61-1 1�-1- �o A� <br /> PID: <br /> DESCRIPTIONOFYi�ORK: F�N�sH prz�r�°� �Cio.��c. 6�9-��1vL <br /> ----------------------------------------------------------------------------------------------------------- <br /> ZO�Y�tVG REVIEYV BY: � ,w•-- DATEAPPROVED: /-Y-o-s <br /> BUILDItVGREVIEWBY: D.4TEAPPR06'ED: �- Y-o�' <br /> ----------------------- <br /> FEES TO BE CHA.RGED: tYlisc. Fees Calczclatecl 8�.�: <br /> PER1�fIT Yes � No <br /> PLAN RE VIE tV Yes � No S,E LVER COtViVECTION <br /> STATE SURCHARGE Yes r� No tiVATER GOt tWECTIOtV <br /> I1�IVESTIGATIOIV FEE Yes No �/' PARK FEE <br /> S�!C Yes No � SITE INSPECTIO��I <br /> Ni�rnber of SAC Units OTHER (specify) <br /> ----------------------------------------------------------------------------------------------------------------------- <br /> ZO�VI[YG CHECb'LIST ZoriingDistrict: NO C/FANGlS <br /> Fire Depa�•trnerct: Post Offtce: Scl�ool District.• __,. <br /> Lot.�(rea: Sq.f't. Acres 6Yicfth Depth <br /> 5�cr-vey Sub»iitted; Yes No Date of Scr�vey: <br /> Proposect Setbacks: <br /> Frortt(Lalce): Riglit Side: <br /> Reccr•(Street): Left Side: <br /> Adjc�cent Str•uctures: YVetlnnd. <br /> Building Height: Def. Xgt. Peak Kg . <br /> Lot Coverc�ge: � <br /> Grnding.• Staff Approval Dccte: By: Counci!Approvc�!Date: <br /> Septic: StaffApp�•ova!DRte: <br /> Zonir:g File: # Resolc�tio,z: # Resolt�tion Date: <br /> Slioreland Dish•ict: <br /> Avg.Setback: Blc�ff etback: Lot Coverage: <br /> Elisti g Proposecf <br /> Ha�•dcover: 0-7�' <br /> 75-250' <br /> 250-500' <br /> 500-1000' <br /> Harcicover Variance Requir•ed: Yes Date of Couracil Approval: <br /> RE�I�IARKS(i�t liouse): <br /> 31 <br />