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�HEC� p�`�` i.,IST FOR ISSUA.NCE O�' i'ER.�.'YIITS <br /> � FOR OFFICE USE ONLY <br /> .A,pD}.2ESS OR LEGAL: I�10 t3 ��L�� PA2 cc <br /> PD7: <br /> �Escx�o� oF vvo�.: Fa�tio,�,�o,�, ��� paz�.c� <br /> ------------ ------- -- _-- <br /> ------------------ <br /> ZOYNG RE��V BY: DATE APP�OVED: i z-z 9- �6 <br /> SUlZDI1�G REVIE�ti BY: ' . DATE APPROVED: i z- z 5� ��: <br /> FEES TO BE CHARGED:^ ^^ Misc. Fees Calculated By: <br /> PERMIT Yes i/ No <br /> PLAN REVIEti� � Yes �- No ✓ SEti�lE.R CONNECTION <br /> STATE SURCHARGE Yes —� No �VATERCONNECTTO�T <br /> INVESTIGATION FEE Yes No P�RK FEE <br /> SAC Yes No SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> ---------------------------- <br /> ZOi�i G CI�.CK LIST Zaning Distric�: /U U C �-��� . <br /> Post�ffice: School Dis[rict: � ' <br /> Fire Deg:rtmenc: � <br /> T..�oc Area: Sq.ft. <br /> Acres Width Depch <br /> Survey Submitted: Yes No Date of Survey: <br /> Proposed Setbacks': <br /> Froat(Lake): Ri�t Side , <br /> Rear (Streecj: Left S; e: <br /> Adjacent Structures: �Vetland: <br /> Buil�lin�Hei�t: Det, Hgt, Peak Hgt. <br /> Lot Covera�e: <br /> Gradin�. S�aff Approv�i D�te: <br /> gy; Cc�cLL A�pro:,at r1ar=; ' <br /> Sepcic: Staf� Approval Dace: �:�� <br /> Zooin� File: � Reso�ut'ton: n Resolu:ion Da:e: <br /> Shcrelard Distric.: <br /> Avg. SetbacK: BluFf Sec 2ck: IA[Covera�e: <br /> Eust:no Proposed <br /> F-Iz�d�ovei: 0-'/5' <br /> 75-2�0' <br /> 2�0-500' <br /> �QO-1Ct;���� <br /> :.^,r�r�•t�. �;'_'.?1:C' ;:�y'�.:..�. .e5 . <br /> ��'�- -- �O�iar�l A.�ri�VZ: <br /> F.E,�L�'tiKS (�hou�e`,; <br />