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� �CHEC]K Ok'F i.IST FOR ISSUANCE OF i'E��IITS <br /> FOR OFFICE USE ONLY� � <br /> �DDRESS OR LEv-AL: � � oZ i C�;�C[7 �� I�� � <br /> PID: ''-- <br /> �ES CR1�P'TXON OF W ORK: — P-� /�1�'I v c ti�� �S i � - <br /> -----------�----------- <br /> -----------------------'-z------�- <br /> __--------- - <br /> ZOYNG REVIE`V BY: ----------��� ' AATE APPROVED: ���7. <br /> $UILAING R.EYIEtiV BY: � . . DATE APPROVED; �� -07. <br /> F'EES TO BE C�IARGED: Misc. Fees Calculated By: <br /> pEg,�T Yes ,/ No <br /> PLAN REVIEtiV � Yes _� No �-- SE�VE.R CO�INEC"IION <br /> STATE SURCHARGE Yes t� No tiVATER.CONNECTION <br /> INVESTIGATION FEE Yes 1/` Na PARK FEE <br /> SAC Yes No SITEINSPECTION . <br /> Number of SAC�Units OTHER (specify) <br /> ?pNT��IG CH�CK LIS�' Zoaing District: , <br /> Fire Department: Post.Office: School District: � � <br /> Lot Area: Sq.ft. Acces ' Widch Depth <br /> Survey Submitted: Yes N'o Date of 5urvey: <br /> Proposed Setbacks: . n U`.�. .��� w,a �� S' <br /> Froa[(Lake): Rioht Side: �— <br /> �P r`�'�c,, '�Z sld7 <br /> P.ear(5treet): Left Side: Q� _ ? 2�� <br /> J <br /> �P r Crnir��7r . Zyaria�r�j; <br /> Ad;a.,..n_ e", <br /> Buildin� Heioht: DeF, Hgt. Peal:Ho�• <br /> Lot Coverage: <br /> GradLn�: Scaff Apo:oval Date: By: Council_ Approval Date: ' <br /> Sep�ic: Staff Aporov�! Da�e: J �Y� � <br /> 7o�n� File: � Resolutioa: R Resol�tioa Da:e: <br /> Shoretand Distric�: <br /> ' B�LFi Se�SdCk: IA!COve[2�?: <br /> Avg. Setbaco-:: <br /> �t5��o Proposed <br /> H�eco��er: G-7�' <br /> 7�-2�Q' <br /> 2��-��.�.;` <br /> �CO-iC`C''�' <br /> �arC;.O'':2' YZ:_..:.2 '�':;li':2J�. `i2i ,�C �::_ �,': ti�..vi=_�. .-`��_"� =. <br /> t'�1L�.a-�ti fLn h0'��): �_�} 0��..:`1CM J �"?C.L:1C� ��� .1� (� � <br /> �.- . <br /> �-e..+t v�� t $S�,��,/ __— <br />