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� . <br /> � <br /> CHECK OFF LIST FOR ISSUANCE OF PER�I2ITS <br /> FOR OFFICE USE ONL Y � <br /> ADDRESSORLEGAL: 957 sO���G �-1��� �� <br /> PID: � , <br /> DESCRIPTIONOF Yf�ORK: � Ac'�ess sr��2s <br /> ZOtVItYG REVIEYV BY:----- - ------ -------------------N----DATEAPPROVED: Y-6 � a� � <br /> BUILDINGREYIEWBY: Dr�TEAPPR06'ED: y-�r�� <br /> ------------------------- <br /> FEES TO BE CHARGED: �%lisc. Fees Cn(culated By: <br /> PERtYtIT Yes � No <br /> PLAN REVIE 6V Yes �/ tVo SEtYER GOtViVEGTION <br /> ST�LTE SURCHARGE Yes [/ tVo tT/ATER C0�INECTIO�V <br /> . It�IVESTIG.4TIONFEE Yes No PARKFEE <br /> SAC ,Yes tVo SITE INSPECTION <br /> Ntiunber of S.4C U�iits OTHER (specify) <br /> ZO�VIIYG CHECh�LIST r Zot�i►tg Dish•i�l "'___�C __��-C ti�� <br /> Post O cce: Sclxool District: _.. <br /> Fi�•e Deparhnertt: ff <br /> Lot�{rea: Sq.ft. �{cres �Vidth Depth <br /> Sccrvey Subrriitted; Yes No Date af Su�vey: <br /> , Proposed Set6c�cks: <br /> Froru(Lal:e}: Rigl�t Sid : <br /> Renr(Sh•eet): Left Sici : <br /> Adjncent Su•uctures: Yl�etland: <br /> Building Height: Def. Hgt. Peak Kgt. <br /> Lot Coverage: � . <br /> Grading: Staf}'App►'ovc�!Dc�te: By: Coa�nei!Approvnl DRte: <br /> Septic: Staff�lppraval Date: BY� <br /> Zoning File: # _ Resolutiai: # �' Resolt�tiai Date: _ <br /> Shorelaad Dish•ict: '' LotCovera e <br /> Avg.Setbnck: Blccff 5'�tback: g � <br /> � Esisting Proposed <br /> XRrdcovel•: 0-75' --- <br /> 75-250' <br /> 250-500' —;— . <br /> 500-1000' ' <br /> Hardcover Yariance Requireci: Yes Date of Cae�ncil Approval: ` <br /> RE112AR.KS(iEi'liouse�: <br /> ;3 <br />