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I . • <br /> �CHECK �FF �IST FOR TSSUANCE ��' �E�'�'RTS <br /> FOR OFFICE USE ONLY� . � <br /> A,I}DRE�S ORLEGAL: '�Ib�� C �'�c�� y�`� `���' 1 . <br /> P�: " - !'�� � r "�#/' �� <br /> O�t OF WORK: n " ^ , � -;- `' . <br /> �ES CRIP'I'I � � �� " � <br /> ------------------------------ <br /> ------------ - � <br /> ZOYI�IG �tEVJE�V BY: ------�______�---- J�ATE APP�OVED: C� � <br /> $UI'LDING REYIE�V BY: I�ATE APPROVED: � -Z- 0'1. <br /> �'EES TO BE C�7ARGEU: Misc. Fees Calculated By: <br /> P���T Yes � No <br /> PLAN REVIEtiY � Yes —�� No SE�YE.R CO�INECTION <br /> STATE SURCHARGE Yes —� No tiVATF�CONNECTION <br /> INVESTIGATION FEE Yes �0 � STTEINSPECTION <br /> SAC Yes No <br /> Number of SAC�Units OTHER (specify) <br /> ------------ <br /> ------------------------/!-v--- <br /> �,pyT��ICr C�E.CK LIST Zoaing Distric�: �. � —/�� . <br /> Fire Department: Post.Office: School District: � � <br /> L,ot Area: Sq.ft. <br /> Acres W idch Depth <br /> / � -��� - ��� <br /> Survey Submitted: Yes 1/ No Date of Survey: <br /> Proposed Setbacks`. � : <br /> Froa[(Lake): %'�f�'1 Rioht Side: ' 6'�� , <br /> F <br /> � <br /> pe� �}; J Left Side: /7f�' <br /> c���3�P�� Srniri�1r�:; //�'" ��/arlZ*1�; <br /> � <br /> auil�in� Hei�[: DeF, H�t. �7�� Pe��'��� <br /> Lot Covera�e: �� f�" <br /> GradLn�: Scaff Approval Date: By: Council_Approval Date: ' <br /> Septic: S�aff Aporov3! Date: � '1� "b� _ �Y� ��' <br /> Zoa�n� Flle: � Resolutioa: n P.esolution Da:e: <br /> Shoczland District: � ��'�'t'1 ` '���j�r' L''� " L� <br /> Av�. Setbzc'�_: B!uf:5et5ack: L.o!Cove2�e: <br /> �t���o Proposed <br /> H�ecaver; G-7�' n�� C�V�t�ia� <br /> 7�-250' ^ -� �, <br /> �� � <br /> 2Z��' '-.� � h,�,t �:r� �► '�/�i5 <br /> �„� _, ,,, <br /> _` n�yL:-2J: �i'pj i,i� J:.._ V. L.V'_-� .-��_ � :_. <br /> j--ta-Ci.O'';2' Y z:_.� : - <br /> ���T'-'�i�� (Ln h�'���: <br /> � . . <br />