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.. <br /> " ' CHECb OFF LIST FOR ISSU�o� OF PERI�IITS <br /> FOR OFrICE USE <br /> �DDRESS OFtLEG:�I.: z.?� �sGO PT �O'� PID: <br /> DESCRIP'IZO\ OF «4R�i: ►?.�-`x�4 � ��'n'� <br /> DATE APPROVED: � <br /> ZO\�G REti'I�V BY: N�� DATE ?�PPROV�D: 3 -6-5� . <br /> BL-II.DL\G RE`�tiV BY: <br /> FEES TO BE C�-L�RGED: � �o <br /> l�lisc. F�s Calculated By: <br /> PE�tifIT Yes S��CONiy`ECTION <br /> PL.�v REVIE�V Yes v� � <br /> ST:�TE SURCH.�RGE Yzs � vo �`°'� C������ <br /> No PARK FEE <br /> INVESTIG:�TIOv F�E Z'�S v S� �SPECI�ION <br /> SAC _VeS ' ° QTHER (sPeciry) <br /> Numoer of S�.0 tinits _____._._ <br /> � Cii LIST LOIIlII� Discrict: S ore?2�d DiSiIICI : <br /> ZONL�G C� ; <br /> Sch�ol Dis��: <br /> Fire Depanmen�: f Post Off:ce: � ; <br /> � Denth <br /> Acres ' Wlatn f <br /> Loc?.rea: Sq.fr. ; <br /> ( ��o Dace of�urvey: <br /> Survey Suomicted: � es � <br /> 1 � � ' <br /> Proposed Setbac!cs: �, � '� �; <br /> F:ont �Lal:e) � Rigut Side: � i <br /> � � i <br /> Re:s (Street�: � _�_ i--en Side: i <br /> 1 � <br /> r � ir i <br /> ' ��etland: � <br /> Adjacen� S�ruc:ures: '� �`� , <br /> �eai� Hgt.� � <br /> Building Hei¢hc: �ez. H�t. ! <br /> � Bl�ff Secbacic: i Loc Coverage' <br /> Avg. Sezbacic: , ,,.-- � <br /> � j i <br /> ' oposed <br /> E isting � <br /> Hardcover: 0-7�' , I <br /> 75-�`0 �; -- <br /> �50-�00' '�, <br /> �GO-1000' j i <br /> i <br /> Hardcover V 'ance Rev,uired: � . o Daie oi Council Appro ai: <br /> Gcadin�: St �� Approval Date: , Bv: Councl 3ppro al Da�e: <br /> I'� By: <br /> Sepcic: Sta� �•pproval Dace: 1 <br /> ZoninQ File: ________— <br /> Resoiucion: � R:solution Dace. <br /> �ti�g�S (in house): <br /> . � 26 <br />