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. � <br /> CH�'CK OFF LIST�'OR fSSUANCE OF PER1ti.fXTS <br /> FOR OFFICE USE O.NL Y <br /> ADDRESS OR LEGAL: S I I-4,flc���l��� N��� <br /> PID: <br /> DESCRIPTION OF Yi'ORh': S1-i�=� I b X i'-1 <br /> ------------------------------------------- --------------------------------------------- <br /> Z0��7NGREVIEY�BY: DATE,4PPROVED: //- 5-�Y <br /> BUILDII��G.REYIEWB�': DATEAPPRO�'ED: /r- � - �]' <br /> ------------------------------- <br /> FEES ?'0 BE CHARGED: �tisc. Fees Cc�lcc�lated By: <br /> PER�fIT Yes ✓� �'�"o <br /> PLAN RE I/IE GV Yes �/' No SE tiY"ER CON�VECTION <br /> STATE SURCH.4RGE Yes c� !Vo tiT%ATER CO�ViVECTI01�' <br /> I[ti'VESTIGATIOIV FEE Yes [Vo !/ PARK FEE <br /> SAC Y"es �Vo !/ SITE NSPECTIOtV <br /> ��,runiber• of SAC U�iits OTHER (specify) <br /> -------------------------------------------------------------------------------------------- <br /> TO!YI�vG CHEC.Ii LIST Zorting District: <br /> Fi,•e Depa,•hnerrt: Post Offcce: Schoo!District: __. <br /> Lot.=trea: Sq.ft. Acres 6Yidtl: Depth <br /> Sc�rvey S��bruitted: Yes Na �_ Date of Scrivey: 5�ri. p��+ <br /> Proposecf Setbacl,s: , <br /> Front(Lalce): 1�u� + Right Side: � � ± <br /> Rear• (St�•eet): S�� �` Lef�Side: 60� <br /> -F <br /> Adjace�zt Str��ctures: 30� �- G�etlarz�l: NI� <br /> B«ildi�rg Height: Dej. Hgt. �•�� Peak Kgt. <br /> Lot Coverage: � C�� lC- <br /> Gradirig: Staff,4pp��ovccl Date: By: Coau�cil Approval Date: <br /> Septic: Staff,4ppr•oi�al Date: gy,� <br /> Zorting File: � <br /> �� Resolution: # Resolcctlo�i Date: <br /> Slcoreland Dish•ict: n)� <br /> Avg. Setback: Bluff Setbacic: Lot Cover•age: <br /> Elisti�tg Proposed <br /> Hardcover: 0-7�' <br /> 75-2�0' <br /> 250-500' <br /> 500-1000' <br /> Narcfcover f/ariance Reqceired: Yes No Date of Couricil�ippraval: <br /> RE1I�IARKS(in hotcse): <br /> 31 <br />