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, �CHE�� pFF i�IST FOR ISSU.ANCE 4F �E��ITS <br /> ' FOR OFFICE USE ONLY <br /> AbDRESS OR 1'�EGA.L; Y 7�5 C2.�.wo�✓� -c'(2/a�� -- <br /> p�: <br /> �E' SC��Q� ��' ���.: l h^�dtr�"L <br /> ZOV�TG REVLE�4V BX: `--------------- D�.Z'E APPROVED: ,n11 h <br /> T�ULLDLNG REVIEtiV BY: . DATE APPROVED: c-�-�t, -o-t <br /> FEES TO BE C�-LARGED: Misc. Fees Calculated By: <br /> PEg�T Yes � No <br /> PLAN REVIEtiV Yes _� No SEti�R CO�N'ECTION <br /> STATE SU"RCHARGE Yes � No �VATERCONNECTION <br /> INVESTIGATION FEE Yes No � PARK FEE <br /> SAC Yes No _� SITEINSPECTION <br /> Numbzr of SAC•Uruts OTHER (specify) <br /> Zp�IGrCHE.CK LIST Zaning District: _Nc) Ci-��9/�►�-Q �. <br /> v <br /> Fire Depar'�aent: Post Office: Schoel District: � <br /> I.,oc Area: Sq.ft. <br /> Acres Width Dep[h <br /> 5urvey Submitted: Yes I�o ate of Survey: <br /> Proposed 5e!backs: <br /> Froa[(Lake): Ri�[Side: . <br /> Rear(�treetj; Left Side: <br /> FidjaCeC� S�Cu�CLra�: �V I137d' <br /> Buil�lin� Hei�.t: Det. Hgt, ea�Hgc. <br /> Lot Covzra�e: <br /> Grading: S�afE r'.pprov� Date: B;: Council Approval DaCe: <br /> Szptic: S�af� Appro•��1 Date: �`.': <br /> Zo��n� F�le: R Resolu:ioe: r P.esolut:�n Da!e: ._ <br /> S;lOCe�?S'_d �lStLiC�: <br /> A.vQ. Seiback: Blu�i Se�ba k: i_acCover�,e: <br /> � E�istino P;oposea <br /> .,,..,,,o.� n_�S� <br /> :���.:_�.. .. <br /> 7�-2�0' <br /> 2��-5�`' <br /> �00-10C��' - <br /> �. <br /> L� _ n-, - r-�„��;I e r,� �va_. <br /> .:�'�_..,.. jr�._....._ , ..��.... a–_ . _.' -.' _ . . __—.— <br /> r r�f �.�.�-'.`�J �' r�0���e�: <br /> ,..� � - <br />