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� ` CHECR OFF LIST FOR ISSIIANCE OF PERMITS <br /> � FOR OEFICE USE ONLY <br /> ADDRESS OR LEGAL: / � / �� ° y=,x•� � - K�'PID: �.J�`� '' �� �" � -3 /`� l''C.'C% Z <br /> DESCRIPTION OF WORR: C.y�A�y(�� Ff�-o✓►1 5�-2��s � �� �v,Daws i� Po2�H <br /> ----------------------------------------------------------------------------- <br /> ZONING REVIEW BY: N�� DATE APPROV$D: <br /> BIIILDING REVIEW BY: �� � ' DATE APPROVED: : Z -y`� ' r7 Z <br /> ----------------------a ----------------------------------------------------- <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT , Yes J No <br /> PLAN REVIEW Yes�No SEWER CONNECTION <br /> STATE SURCHARGE Yes� No WATER CONNECTION <br /> INVESTIGATION FEE Yes No� PARR FEE <br /> SAC Yes No�� SITE INSPECTION <br /> Number of SAC Units OTHER (specify) <br /> ZONING CHECR LIST Zoni g District: <br /> Fire Department: Post Of�ice Sc�hool. istrict: <br /> i / � <br /> Lot Area: Width: Dep�h: <br /> � <br /> t <br /> ;' <br /> Survey Submitted• Y s No Dat of Survey: �' <br /> /� � <br /> Proposed Setbac s: ' ` <br /> Front (La ) : � �� Ric�ht Side: � <br /> � �� 1 <br /> Rear (St eet) : Le�t Side: � <br /> � , <br /> % i <br /> Adjacen Struct�res: F �letland: <br /> I i <br /> Building He' ght: De� . Hgt.+ �i Peak Hgt. <br /> , <br /> � <br /> Avg. Setba � `� �� Lo�/ Coverage: <br /> xisti,hig ,-Proposed <br /> , <br /> ; ; ; __------ <br /> Hardcover. 0-75 ' ` � ' <br /> / '� �, <br /> 75-250 ' � <br /> ; <br /> 250-500 ' �� ,� <br /> I '/ ' <br /> � , / <br /> 5oo—i000 � ' , <br /> Hardc ver Variance e uired�/ Yes;� No Date of Council Approval: <br /> , <br /> Grad ' g: Staff Appr aI. Dat1'e:_ � By: Council Approval Date: <br /> / <br /> Sep ' c: Staf f Appr al. Da�e: BY= <br /> i � <br /> Zon ng Fi�e: # /Reso ution �: Reso].ution Date: <br /> i <br /> S (in house) ' � <br /> � <br />