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CHECK OFF LIST FOK ISSUAIVCE OF PEI�tiIITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: zZ b (3i b �s� - <br /> PID: ' <br /> DESC��IPTIO:V OF yl�ORIC: To�� �3��1��� <br /> ------------------------------------------------------------------------------------ <br /> ZOtVI�YGREVIEyi�BY: DATEAPPROVED: Z-ZY-o�' <br /> BUILDIIYG REVIEW -8Y. �ATEAPPROG'ED: 2 • z..� a 5 <br /> --------------------------- <br /> FEES TO BE CHARGED: h'Iisc. Fees Calctcfated By: <br /> PERILIIT Yes ✓ !tio <br /> PLANRE�IEGV Yes ✓ �Vo SEWERGO�VNECTION <br /> ST,�TE SURCH.4RGE Yes�� �vo tiVATER CO�Wi ECTIOIV <br /> I�VVESTIG,4TIOtV FEE Yes tVo PARK FEE <br /> SAC Yes Ivo SITE NSPECTIO�V <br /> Number• of SAC Units OTHER (specify) <br /> -------------------------------------------------------------------------------------------------- - - - <br /> ZO�VIIVG CHECh'LIST Zor�i�t�Dist��icc: <br /> Fire Deparhrterrt: Post Office: School Dish'ict: __.. <br /> Lor,�{rea: Sq.ft. Acres �Yicfth Depth <br /> Scuvey Scebmittecl: Yes�C_ No Date af Sctrvey: on� F�c.� <br /> P�•oposed Setbacks: � i + <br /> F,•or�r(Galce): 1�5 Right Side: . `{�6 <br /> Renr(Str•eei): 1 Oa� Left 5ide: �°� � <br /> Adjacent Str•ucuu-es: N �� G�etland: f9•� <br /> Building Height: Def. Ngt. Q � Peak K,;t. cZ � <br /> Lot Coverage: � N (l� <br /> Grading: Staff.4pproval Date: — By: Cotuicil App�roval Date: <br /> Sepcic: Staff,�ppr�ovaf D�te: — BY� <br /> Zonittg File: # Resofution: # Resol<<tion Dnte: <br /> S/toreland Dish•ict: �IO,� <br /> Avg. Setback:, Blc�ff 5etbnck: Lat Coverage: <br /> Elistin� P�'oposed <br /> Har�dcover: 0-7.5' 6�� <br /> 75-2�0' <br /> Z50-500' <br /> 500-1000' ' <br /> Hardcove�• Var�iarice Reqaiir•ed: Yes No� Date of Coiirtcil Approval: <br /> RE1I�IARKS(in house): <br /> 31 <br />