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�CHECg Ok'�k' LIST FOR YSSUANCE OF ����TS <br /> �OR OFFICE USE ONL1'� � <br /> ADDRESS ORLE�AL: � � r� <br /> PID: : c��t- ►Zz��o-e<- <br /> O� OF WORK: - �`' 1�`^"� '�`' <br /> pE5 CRIP'I'I .------ -�'- ------- <br /> ------------------- <br /> ----------------- <br /> ________------- -- -- — -- - ---- -= <br /> ^ YIi�TG �ZEVIE�V BY: ^ ,{�'�t D�,.TE APPROVED. I I J C� <br /> ZO D.A.TE APPROVED; -� - 1 e - o'-7 <br /> $UII�DING REVIE�V BY: . � . . <br /> �`EES TO BE CHA-RGEA:` �/ Misc. Fezs Calculated By: <br /> P���T Yes ✓ No <br /> PLAN REVIEtiY � Yes f No SE�VER CO�INECTION <br /> tiVATER CONNECTION <br /> STATE SURCHARGE YeS � NO FEE <br /> INVESTIGATION FEE �'e5 N0 --�- SITEINSPECTION <br /> SAC Yes No <br /> OTHER (specify) <br /> Number of SAC�Uruts __________ ______________________ <br /> --, -r------------------- <br /> ------------ <br /> ----'---�------"_ � <br /> �p1,�'l��IG �CH�CK. L�S�' Zoai.ng Districc: _ • <br /> Pos[Office: School District: � � <br /> Fire Dep3rtment: , <br /> L,ot Area: Sq.ft. �'� f � �� i Acces ;J ' `�� �'I Width � D U � Depch <br /> Survey Submittect: Yes <br /> �o x Date of Survey: <br /> �roposed Setbacks: �o t Side: ' � <br /> Froat(Lake): � � <br /> Rear (Street): Left Side: <br /> �dj3.r.P.^.f Srnir��1r�.:: <br /> tiVPrl�d; <br /> Buil�lin� Hei�i[: DeF. Hgt. _� Peak.H�t. <br /> Lot Covera�e: <br /> Gradin,, Staff App- B Council Approval Date: ' <br /> o• Loval Date: Y� <br /> 5 e�+�c ,�e.�.�.., <br /> Szp�ic: Staff Approva! D2te: �L7�'e� ��''� �y: �� <br /> �� <br /> Resolutioa: „ Resolution Date: <br /> 7oa�n� File: ��__ — <br /> Shorzl2r�d DiStfic�: �,Ca�,e��,� <br /> AvQ. Setbac;�:: BIuF�Setback: � �_. <br /> � Propose� <br /> E�stino <br /> H�ecavec: G-i�' <br /> 7�-2�0' ----- <br /> 2�V'���J <br /> ,�� <br /> ����J-;�'�'v <br /> n� �� � ��V J: _ O: �v��._=�. n�_ � –" — <br /> }-I a r�;•�'�'':'C' Y��.�..'.� _ ..:;l:'.:�.�i, i Z� • <br /> r�1L'�:-�ti (Ln hp'��): <br /> �. . <br />