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� CHECK OFF LIST FOR ISSUAIV�CE OF PER�tiIITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 3Z.(�S C�R�A�l ���✓� <br /> PID: ' <br /> DESCR.IPTIONOFY�ORK: - nri� c�►AI( T-� `I-` f�P`Au �.c'`' �- 'p-eWC <br /> -- - ------------------------------------- ------- --------- <br /> 7_OtVItVGRET�IEGVBY: .D.ATEAPPROVED: 2• 3 , b5� <br /> BUILDIIYGREVIEYVBY: .DATEAPPR06'ED: 2• 3• bs <br /> --------------------------- <br /> FEES TO BE CHARGED: .tL'Iisc. Fees Calcc�frcted By: <br /> PERNIIT Yes � !tio <br /> PLA�V RE I/IE GV Yes ✓ No SEYVER CONNECTION <br /> STf1TE SURCH.4RGE Yes �/ t�Io tiVATER GOtWECTIOIV <br /> I�VVESTIGATION FEE Yes No PARK FEE <br /> S.�!C Y"es No SITE NSPECTIOtV <br /> Nuntbey of SAC Units OTHER (specify) <br /> ------------------------------------------------------------------------------------------------ - <br /> 2'O�VI[YG CHE Ch�L.�ST Zor�i�t;District: C�2-�3 <br /> Fire Deparhrierrt: Post Office: Scl�ool Disti•ict: __. <br /> Lor.�(�-ea: Sq.fr. ►'S,b'7`� Acr•es . 3� 6�idtli �i5� Deptli <br /> Scc�vey Su6rnitted: Yes�_ No Date of Scuvey: <br /> Proposed Setbad:s: <br /> Fror�c(Lal.e): Right Side: <br /> Rear(Sb•eei): Left Side: <br /> Adjacent Str•uct�u•es: Wetlancf: /VO GN�4N�-Q <br /> Building Height: Def. Hgt. Peak Kgt. <br /> Got Coverage: �22• � <br /> G�•adirig: Staff,4pprovcll Date: �- 3 - O S By: � Coc�nci!Appr�oval Date: — <br /> Septic: Stnff,�lpproval Date: N �/4 BY� <br /> Zortirtg Fife: # oY-3U�S Resolutia2: # Resoli�tio�i Dnte: I-I o-o� <br /> Slioreland Dish•ict: �a��_ <br /> Avg. Setback: N�A Bluff Setbacic: /v / Lat Coverage: <br /> Elisting Proposed <br /> Hm•dcover: 0-7�' s.83 S��3 <br /> 75-Z 5 0' s K.�� <br /> 250-Sb0' ' <br /> 500-1000' <br /> Hardcover Variatice Reqc�ired: Yes,1� No Date of Co�utci!�Ipproval: i- �o -a� <br /> RE1I�IARKS(irt house): <br /> 31 <br /> �J� �) k, . <br /> . . , . . '�I1�� �il��.�� ��xf r��:ip�i i �l^i+�l '�I)Jid'i kv�`R�:��'� dFd����' '"°p� §?�'�'t �'.�i$ �'�, �r� <br />