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, � CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 'j 2 �.�, <br /> PID: `C. <br /> DESCRIPTION OF WORK: �i h�r e c/L c,,�, u,� cle c!C <br /> �_�__w__-------------------- _____---------______�____�____�______�� <br /> ZONING REVIEK'BY: �� DATEAPPROVED: 6 O <br /> BUILDING REi�IEW BY: DATEAPPROTjED: ,y -f(� - �� <br /> FEES TO BE CHARGED: Misc. Fees Calculated B}� � � � � -'�____ <br /> PERMIT Yes ✓ No <br /> PLAN REVIEW Yes �/ No SEu'ER CONNECTION <br /> STATE SURCHARGE Yes� No u'ATER CON.�VECTION <br /> INVESTIGATIOIV FEE Yes No ,/' PARK FEE <br /> SAC Yes No �� SITEINSPECTION <br /> Narmber of SAC Units OTHER (spec�) <br /> �_�__�-------------------------___---��____________________-------------------------------- <br /> ZONING CHECK LIST Zoning District: /�le'l,/..� <br /> Fire Department: Post Offce: School District: <br /> Lot Ar•ea: Sq ft. Acres Gi�idth Depth <br /> SurveySubmitted: Yes ✓ No Date ofSurvey: �S 6„�.�� p�`jwJ� <br /> Proposed Setbacks: ���r ���4-' S�}u�.vn f�x�S�i+t��„�a(' <br /> Frront�.-czf�J' %j _ ��Side: d/C. <br /> �c,�',�.e s F t i l�/4E�.,.n.�� � <br /> Rear(Str-eet�: /1��/11�.� Ltft Side: � <br /> Adjacent Structures: ? YT'etland: <br /> Building Height: Def Hgt. � Peak Hgt. <br /> Lot Coverage: �� <br /> Grading. StaffAppr•oval Date: B}': Council Approval Date: <br /> Septic: Staff Approval Date: gti�; <br /> Zoiaing File: # Resolution: T Resolution Date: <br /> Sho�•eland District V NICWD Pe�-mit: <br /> .Avg. Setback: BlarffSetback: LotCoverage: <br /> Existing Pr-oposed <br /> Hardcover: D-'.i' <br /> ?s-�s0' OK_ <br /> ?so-soo� <br /> .i 00-1000' <br /> Har•dcover 6 ai-iance Requir-ed: }es �'o v Date of Council.9pproval: <br /> REMARKS(i�z house): <br /> .i 3 <br />