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� -CHECK OFF i�IST FOR ISSUA.NCE OF PE�'VIIT5 <br /> FOR OFFICE USE ONLY <br /> A.DDRESS OR IIEGAL: �y(�S ��S% GA/� si�r.c� T <br /> PID: <br /> DESCR�'�ION OF�VORK: �H-n-+ �oa�. (��^.A�o-ec_ - <br /> __-�______--- __�___.._---- <br /> ----------- <br /> ZOYPi tG REVIEtiV SY: ----- I f� DATE APPROVED: <br /> S U�L D L N G R E V I E ti V B Y: ' . . DATE APPROVED: /� L1-U G ' <br /> k`EES TO BE CHARGED: ^ Misc. Fees Calculated By: <br /> PE�IT Yes � No <br /> PLAN REVZEti�T � Yes -� No SE�VER CO�ECTION <br /> STATE SURCHARGE Yes � No �VATERCONNECZION <br /> INVESTIGATION FEE Yes No ,/' PARK FEE <br /> SAC Yes No -� SITEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> - --- N <br /> --------------------- - <br /> ZpN1�G CHE.CK LIST Zoaing Discric�: ' v C l-/�-N� . <br /> Fize Dep:rsuent: <br /> Post Office: School District: • <br /> jAr p,rea: Sq.ft. <br /> Acres Wid�h Depct� <br /> Survey Submitted: Yes Iv`o ace oE Survey: <br /> Proposed Setbacks`. � <br /> Froat(Lake): Rioht Side: , <br /> Rear(Streetj: Left 5ide: <br /> Adjacent Struch!res: Vetland: <br /> Buil�lin�Hei�t: Det, Hgt, Peak Hgc. <br /> Lo[ Covera�e: <br /> Grading: Scaff App_ov�l Date: <br /> F�+y: ��.,Gi:u::Cii n�a:CV:,t na(�; . <br /> Szptic: Staf� Approval D3ce: �:�� <br /> Zoain� F:le: R Reso?utioe: n Resolution Date: <br /> She�et�^.d Distr'cc� Lot Covecage: <br /> �v;. Setback: Bluif Setb ck: <br /> E�st�o P;oposed <br /> Hz�Ccover; 0-75' <br /> 7�-L�0' <br /> 2�0-5�' <br /> �oo-.�;��� <br /> _ n�.� �.= �'c����,�;i a;�-�•.z: --- <br /> �_�a.rr�,;°' �,�_;,�`� ��.eti'!ti��:: :e� . �- • . r• _ <br /> �.�.�L:�,.�;5 (�nhouse): <br />