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CHECK OFF LIST FOR ISSUANCE OF PE.R1vIXTS <br /> ' FOR OFFICE USE ONL Y <br /> ADDRESS OR LEGAL: / `'I .3b < <� C r" l �( f��✓��P <br /> PID: <br /> DESCRIPTIO:V OF ti�ORK: N�,c�1 2�S <br /> ----------------------------------,p------- - ----------------------------------------------------------- -- --1�- -- <br /> ZONItYG RE VIE Gv B Y: Y `' �C���"�� D.A TE APPR O VED: � �L((' U� <br /> BUILDXtYG.REV.IEWBY: DATEAPPROt'ED: � •ZI-C�(� <br /> FEES ?'0 BE CHARGED: Ntisc. Fees Calculated By: <br /> PERNIIT Yes � No <br /> PLAN REVIEGV Yes � tVo SEWER CONNECTION <br /> STATE SURCH4RGE Yes � Ivo � tiVATER CO�WECTION <br /> I�VVESTIG,4TIO�V FEE Yes � �Vo � PARK FEE <br /> SAC Yes 1Vo SITE NSPECTIO�V <br /> Nc�nzber• of SAC U�zits �n .s � LlS6� q-Z�.-�I OTHER (specify) <br /> ------------------------------------------------------- ---- ---------------------------------------------------------- <br /> Z01VI�YG CHECh�LIST Zor�ing Disrricr: � � <br /> Fire Deparhnerrt: Post Office: Sclxool District: __. <br /> i� <br /> Lot.�(rea: Sq.f't.���_Acres 6�itlth � Deptlt <br /> Sc�rvey Subntittetl: Yes X'; No Date of Swvey: �� v`'' <br /> �� <br /> Proposed Setba •s� /J � � -��� �j� '�� (�� , � l <br /> Fron ( ke . ` Rigl�tt`��lde: �_ <br /> ���� l �� <br /> Rear•(Street): ��' Le t i e �?7 <br /> � <br /> Adjace�2t Sh•c�ct�u•es: �3 y�etlR�zd: /�• <br /> i ' "� � <br /> BuildiirgHeight: Def. Hgt. 2K� 5 PeakKgt. 2� � I�_ <br /> Got Covei•age: �O� ► !� I �- � <br /> Grading: Staff,4pproval Date: �' Z5�' v�O By: � Cotulcil Approval Dctte: �' <br /> Septic: Staff,�(pproval Date: � `�� gy �"� � <br /> Zo��i�rg File: #�� Resolutiai: " Resolc�tiolz Date: 6 'L(a•b�o <br /> S/toreland Dish•ict: <br /> Avg. Setback: U.l<-.. Ble�ff Setback: N ��' Lot Cover•aoe: /'� � � • � <br /> E.risti�tg Pro os d <br /> Har•�fcover: 0-7�' S.7 9 c..-T�t►y»r 5 <br /> 75-7�p' Z lt 5T�'�I2 �-w/XC <br /> 250-500' <br /> 500-l000' <br /> Harcfcover f/arimice Reqccired: Yes No� Date of Co�uacil�ipproval: <br /> ,RE1I�IARKS(i�t lzotcse): <br /> -,, <br /> �� <br />