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CHECK OFF LIST FOR ISSliAtVCE OF PER�ti,fITS <br /> FOR OFFICE USE ONL Y <br /> ADDRESS OR LEGAL: I I 5 CH cv Y C I-� A S� - <br /> PID: <br /> DESCRIPTIONOF Yi�ORh': ��� � -r i o�1 — <br /> ------------------------------------ ------------------------------------------------ <br /> ZOt�7NG RE VIE t�B Y: ,,_ D.�4 TE APPRO VED: l�-S • �Y <br /> B UILDING RE VIE W B Y: DA TE APPR 0 6'ED: ��- 9 � °Y _ <br /> ------------------------------- <br /> FEES TO BE CHARGED: hlisc. Fees Calczclated By: <br /> PER�fIT Yes �� ��'o <br /> PLAN RE I/IE 6V Yes ,/ No SEYVER CONNECTIOIV <br /> STATE SURCH,4RGE Yes � 1Vo tiVATER CO�Vt�IECTIOIV <br /> ItVVESTIG.4TIO�V FEE Yes [Vo ✓ PfiRK FEE <br /> S.AC Yes [vo _/ SITE NSPECTIO�v <br /> [Vumber� of Sf1C U�zits OTHER (specify) <br /> ----------------------------------------------------------------------------------------------- <br /> ZO[vI�YG CHEC.Ii LIST Zoning District: <br /> Fire Deparhfiertt: Post Ojjcce: ScJeoo!District: ___. <br /> Lot.�(rea: Sq.ft. Acres GYidth Depth <br /> 5cvvey Subncitted: Yes ,/ Na Date of Stuvey: !��Z�i -U`i <br /> Pr•oposed Setbacics: , <br /> Frorit(Lalce): SS� Right Side: (05 <br /> i <br /> Rear (Sd•eet): ,�0 Left Side: �-7•� <br /> Adjnceiit Stra�ct�cres: 10' G�etlarid: <br /> Builcting Height: Def. Hgt. O.�<. Peak Kgt. <br /> Lot Coverage: � ��•S� <br /> Grading: Scaff Approvcc!Date: I I —l�l '�Y By�__(2._ Coc�ncil ripp��oval Date: <br /> v <br /> Sepcic: Stnff,4pprovc�!Date: — BY� <br /> Zorii,:g Fife: # Resolutia:: # Resolution Date: <br /> Sltoreland Dish�ict: ✓�� <br /> Avg. Setback: Bluff Setback: Lot Cover•age: <br /> Ecistiizg Proposecf <br /> Hardcover: 0-7�' <br /> 75-2�0' <br /> 250-500' <br /> 500-1000' <br /> Nardcover Variatice Regceir•ed: Yes No Date of Co�uicil�Ipproval: <br /> .RE1I�IARKS(in faouse): <br /> 31 <br />