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CHECK OFF LIST FOR ISSLIAlYCE OF PER1ti,fITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: I 7 s G v�oc�v��e w O/z• <br /> PID: ' <br /> DESCRIPTXO:V OF 6fjO,RK: n/�� � T� � � <br /> ------------------------------------------------------------------------------------------ <br /> ZOtVI1VGREVIEGVBY: D.ATEAPPROVED: z-�-�s <br /> B Ll'ILDIIV G RE VIE W B Y: �.�(O�. --- ----- DA TE APPR D 6'ED----2-�=o s- -- -- <br /> ---------------------------------------�-5---------------------- - - - - - <br /> FEES TO BE CHARGED: !L'Iisc. Fees Calct�lated By�: <br /> PERNIIT Yes ✓ No <br /> PLAtV REVIEGV Yes ,/ tVo SEYYER COiV�V'ECTIO�V <br /> STATE SURCH.4RGE Yes � tVo tiVATER GO�WECTIOIV <br /> I��IVESTIG,4 TIOIV FEE Yes �Vo ✓ PARK FEE <br /> StIC Yes ��lo _�� SITENSPECTIO�V <br /> Niva�6er• of SAC Units OTHER (specify) <br /> ------------------------------------------------------------------------------------------------------ - <br /> ZO�YIIVG CHECh'LIST Zor�i�tg D�sc��icc: <br /> Fire Deparhnerrt: Post Off ce: School Dist�ict: __.. <br /> Lo�.={rea: Sq.f't. ,dcres �Yicftli Depth <br /> Su�veySubrni[ted: Yes �C No DateafSeuvey: '�-I�• '��7 �o�v x��� <br /> Proposed Setbacks: �, .� <br /> Fi•ortt(Lake): l SS� ± Riglzt Side: <br /> Renr(Sn�eet): Z-1 S� r Left Side: ��V� ± <br /> .4djacertt Str•uctcu•es: AT4�cNc:.� 4�etlanc(: N�A <br /> Buildiiig H�ight: Def. Ngt. C�.,L Pea�Kgt. <br /> Got Coverage: � N/l A <br /> Grading: Staff.4pprovccl Date: — By: Council r(ppiroval Date: <br /> Septtc: ScnffApprol�af Date: BY� <br /> Zonirzg File: # — Resofutiat: # Resolution Dnte: <br /> Sltoreland Distr•ict: Na <br /> Avg. Setback: Bluff Setback: Lat Cover•age: <br /> Etistin� Proposerl <br /> Har�dcove�•: 0-7.i' <br /> 75-2.i0' <br /> ZSO-500' ' <br /> 500-1000' <br /> Hardcover Varimtce Reqc�ired: Yes No Date of Co�i�tcil Approval: <br /> REtI�lARKS(in house): <br /> 31 <br /> ; <br />