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. � <br /> CHECK OFF LIST FOR ISSUANCE OF PER1ti.tITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: Z Y 1 � �O�N u�-o«.� <br /> PID: <br /> DESCRIPTIO:�%OF �[�OR£�': f'�-�'�e ��� <br /> ---------------------------------------------------------------------------------------------------------------- - <br /> ZOtvINGREVIEti�BY: l/� D.ATEAPPROVED: <br /> BUfLDI�vGREVIEWB�': DATEAPPR06'ED: rz-�3-b� <br /> -------------------- <br /> FEES ?'0 BE CHARGED: �Iisc. Fees Calcu[ated By: <br /> pE'R�LIIT Yes _� No <br /> PLAN RE VIE iV Y'es �vo � SE yl"ER CONNECTION <br /> STATE SURCH.4RGE Yes _r� tVo tiVATER COtVitiECTIOtV <br /> IttirVESTIGATIO�V FEE Yes No P�?RK FEE <br /> S.�C Yes !Vo SITE NSPECTION <br /> Number of SAC U�tits OTHER (specify) <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> ZO�YI�YG CHECb'LIST Zar�irtg Dist��ict: /(Jo Cffei <br /> Fire Deparhnertt: Post Off ce: School Distrlct: ___ <br /> Gar.�lreR: Sq.ft. �lcres �Yidth DepNt <br /> Survey Subniitted: Yes o Date af Su�vey: <br /> Proposed Setbacl;s: <br /> Froru(Lal:e): Righ Sr'de: <br /> Rear• (Sh•eet): Left Side. <br /> Acfjacerit Sn�c�ct�cr•es: Y� land.• <br /> Bctildi�ig Height: Def. Ngt. Pea 'K,�t. <br /> Loc Coverage: � <br /> Gradirig: Staff.4pproval Date: B : Cow2cil rippraval Date: <br /> Septic: Staff,4pproval Date: y'� <br /> Zo�tiizg File: �* Resoli�tio��: # Resol«tiori Date: <br /> Sltoreland Dish•ict: <br /> Avg. Setback: Bluff Se bacic: Lot Coverage: <br /> Existiit Praposed <br /> Har•dcover: 0-7�' <br /> 75-2�0' <br /> 250-500' <br /> 500-1000' <br /> Hardcover Varia�ice Reqc�ired: Yes No Date of Couricil Approval: <br /> RE�I�fARKS(iri house): <br /> 31 <br />