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, . , <br /> �CKEC]K pFF i�IST FOR TSSUANCE OF 3'E��TS <br /> FOR OFFICE USE ONLY <br /> �,.pDRESS OR LEGA.L: o `1 O A (Jt�1,.� <br /> PID: �w�c! S�, ,�,v+��viti �oc; � �l O� b�,v� <br /> �7ESCRIPTI��T 4F WORK: �►� <br /> _-----_____.------ ------------____�__'------------- DATE APPROVED: <br /> ZO�'1NG REVIE�V 13Y: , DAT'E APPROVED: <br /> �UILDING REVIE�V �Y: . <br /> FEES TO BE C�T..��G-Ep: r Misc. Fees Calculated By: <br /> PERMI.T Yes N� — <br /> PLAN REVIEtiV � Yes No . SE�VER COI�TNECTTON <br /> No tiVATER CONNECTION <br /> STATE SURCHARGE YeS Na p��{ FEE <br /> II�iVESTIGATION FEE Yes N,o STI'EINSPECTION <br /> SAC �'es — <br /> OTHER (specify) <br /> Number of SAC�Uruts ______________________________ <br /> ------------------------------- <br /> _____. <br /> --------------------------- f� f,�t <br /> ZQ! � G C�CK LIS�' Zoaing Distric�: � � <br /> Post Office: Schaol District: � � <br /> Fire Dep3.rt.ment: . <br /> Acres 7Ac� Widch �S � Dep� 5`{ � <br /> L,oc Area: Sq.ft. . <br /> / �o Date of Survey: S � � 7 <br /> Survey Submitted: Yes ✓ <br /> � 1��� , cLa�.C� , <br /> Proposed Secbacks: n�+� ' <br /> Froat(Lake); -��t Side: S 3 �I'��s�v� , <br /> �3' tleu�- <br /> P.ear�e�)� �'� " l'f'�1�� Left Side: <br /> �P�r c���cn�r�s; li7s /� tiVet!?�d; I��I� <br /> ��d;a.,..... <br /> J <br /> Buil�lin� Hei�t: DeE, H�t, �� �e�`�'d�. M <br /> Lot Coverage: �?/�- <br /> Gradi.n�: ScaEf Approval Date: _ <br /> gy; Council_ Approval Date: ' <br /> ��pcic: S�af` Approv3. D°t'-: �' �` � �v: �� <br /> Zoa+n� Flle: �'____ <br /> Resolutioa�. n_____ RP`olu�ior: Da:e: <br /> �ho�e;�,d Dist:icc: �1� 7.,.��Cav?2ge: <br /> ��,� �e��ba�,�:. E',�,!f�:Set�ack <br /> �ts��c p;oposed <br /> H�ec�vPr. G_7�' —_.--- <br /> --- <br /> 7�-2��' — <br /> ---- <br /> 7lV"J�JM1J, _ <br /> -�� <br /> ��'J`�-.v.i� <br /> ��_r,`�. ar .'a; ___.`_ C'_yG'.'2�', I2� �;� __._ �. �v'.=_._. :� —_ � --, <br /> [;^1 T .�T.{�1 �� _ ["i��'.t:=� <br />