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�CT3ECK p�'F i,IST FOR ISSUANCE �F �E�'VIITS <br /> FOR OFFICE USE ONLY� � <br /> A.DDRESS OR LEGAL: �2.�t� � �l�e 1 /!)�1-e <br /> PID: <br /> �ESCRIP�I�N OF WORK: IO�-.T�- - <br /> -------- <br /> ------------------------- <br /> ------------ -------_---_ D: � 23 0 <br /> ZO.Y�i G REVIE�V 73Y: '��" ^ ^ DATE APP�OVE <br /> $UII�DING R.EVLE�V BY: � . . DATE APPROVED; �-zg• 0-7. <br /> �'EES TO BE CHA�2GEA: ! Misc. Fees Calculated By: <br /> P���T Yes � No <br /> PLAN REVIE`�V � Yes —� No SE�VER CO�INECTION <br /> STATE SURCHAR.GE Yes (� No tiVATERCONNEC'I'ION <br /> INVESTIGATION FEE Yes No r//� PARK FEE <br /> SAC Yes No �/ STTEINSPECTION <br /> Number of SAC�Units OTHER (specify) <br /> -------------------------- <br /> ---------------------------------- - <br /> �,pyT��tG CH�CK LIST' Zoaing Districr. �..2� ��_ . <br /> Fire Department: Post Office; School District; � <br /> L.ot Area: Sq,ft. ��00(Z._Acres � Widch Depth <br /> Survey Submi[ted: Yes � I`jo Date of 5urvey: Z U <br /> Proposed Setbacks: na c L . : <br /> Froa[(��: q Riaht Side: 'r10 �-�1Pv�9'�- . <br /> peaz.���; � Left Side: rc' �Gw�►9e- <br /> �hd'a.!`.P�f Crnir7lrz:; n p tiVPtl2rld: <br /> J <br /> auil�lin� Hei�t: DeE, Hgt. h/a1 Peal�Ho�. <br /> Lot Covera�e: � 2' •Z Z� <br /> B Counc�Approval Dace: ' <br /> GradLn�: Staff Approval Date: {�lla► Y� <br /> Szptic: Staff Aporovai Date: �Y� �� <br /> 7oain� File: � N/a Resotutioa: rt Resolutioa Da'z: <br /> Shoceland Distric�: ✓ � <br /> Avg. Se[back: !il A- B!�f:SetSack: /)� Lot Covera�e: <br /> �t�t�o Proposed <br /> H�cco��er: G-i�" <br /> �� <br /> 7�-2�4' �-- <br /> 2�o-s�.��' 1 5•SR %U —�`{'�/v <br /> �����-ic`���, <br /> j-ta�Ci.p`:2' YZ..___.�2 ��,yl:'.:2J. ;?i ��� :i_-- 0: ��'�.-_� n�_ � =�: <br /> L'.�1L'`�:-�� �_Ln h0'��): <br />