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CHECK OFF LIST FOR ISSUANCE OF PER1tiIITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: 16 S �=cczN r�r��`. (�� (�o�� <br /> PID: ' <br /> DESCRIPTIO.V OF yf�ORK: fLr�oc` — <br /> ------------------------------------------------------------------------------------ <br /> ZO�YI�VGREVIEGVBY: NIA �D.ATEfIPPROVED: <br /> BLiILDI1VGREVI.EW.BY. DATEAPPR06'ED: Z-2,f� -as <br /> --------------------------------- <br /> FEES TO BE CHARGED: /' �L'Iisc. Fees Calcc�faced By: <br /> PERttitIT Yes ,/ 1tio <br /> PLA�V RE I/IE GV Yes � �Vo� SE LVER CONNEGTIO�V <br /> STATE SURCH4RGE Yes�'_u�' tVo G�- tiVATER CONNFCTIOiV <br /> I�VVESTIGATION FEE Yes No Pf(RK FEE <br /> S�lC Y'es No SITE NSPECTIO�V <br /> l�Icunber of SAC U�tits OTHER (specify) <br /> ------------------------------------------------------------------------------------------- <br /> 70�VING CHECh�LIST Zar<i�i,;Disd�icc: /V v Gt1�-7/�.�'�E <br /> Fire Departrnerrt: Post Office: School District __.. <br /> Go�.=(rea: Sq.ft. .�la•es GVitfdr Depth <br /> S���vey Su6rriitted: Yes Date of Scuvey: <br /> Pi•oposed Setbncks: <br /> Fror�c(Lal.e): Right Side: <br /> Rear(Sh•eer): Left 5ide: <br /> Adjacent Str-uctures: G�etland. <br /> Building Height: Def. Hgt. Pe�� �t. <br /> Lot Coverage: � <br /> Grnding: Staff,4pprova!Date: By: Caunci!rlppr•oval Date: <br /> Septic: Stnff.�(ppi'oval Date: BY� <br /> Zazi�tg File: # Resofutiat: # Resolt�tlat Date: <br /> Sltorelancf Dish•ict: <br /> Avg. Set6nck: Blccff Setbnck: Lat Coverage: <br /> Elisting Proposecl <br /> Hardcover: 0-7�' <br /> 75-250' <br /> 250-500' ' <br /> S00-L 000' <br /> Ha��cfcave�• T/af•iafice Reql�ired: Yes o Date of Coe�itcil Approval: ' <br /> REtI�IARKS(i�i liouse): <br /> 31 <br /> ,� <br /> 5., , , <br /> i17�' ��'N����P, Ilbi Id,e � ��+''�P�� ��I ' �I�', 'y��!,_ ��'���' �' i4� ;'�i��' ���hi I��I�G;��I <br /> ,� <br />