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� CHECK OFF LIST FOR ISSUANCE OF PER�.I�STI'S <br /> _ � FOR OFFICE USE ONLY . � , <br /> ADDRESS OR LEGAL: 3 5 3 Z �.�p`f I�L iA c� <br /> PID: <br /> DESCRIPTTON OF WORK: /v�.�w f?,t,s3 <br /> . <br /> ZOtifii'G REY�ti�BY: DATE APPROVED: //:/�-va <br /> BUII..DIYG REY��BY: . DATE APPROYED; II - r 3-�vv . <br /> FEES TO BE CHA�tGED: Misc. Fees Calculated By: <br /> pERMIT Yes �/ No :� <br /> pI,AN REVIEW Yes +�/ No SEWFR COYNECTION <br /> STATE SURCHARGE Yes �No WATERCONNECITON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No SIT'EINSPECITON <br /> Number of SAC�Units OTHER (specify) <br /> _� ----- --- <br /> ZO\�iG C�lE.CK LIST zonin�Districc: L 2 -� �— . <br /> Fite Department: V1n d u nr t/� Post Office: IOQpI.0 ls4 vt-'r►'aSchool District: �e gT+�^'� • <br /> Lot Area: Sq.ft. z i, 2�'�.�B'�Acres � K� �� Width t n o` /J�lp�' � Depth z t ti ' +- <br /> Surve;Suba:itted: Yes� No Date of Survey: d�-'°� �3 d� <br /> Proposed Setbacks: � <br /> Front(La.ke): t 0 3� Rioht Side: ��`/ <br /> Rear(Street): y�� fi- I.tft Side: �� <br /> Adjacent Structures: N�� Wetlaad: N ��' • <br /> Buil�in,Hei�ht: Def. H�t. 'Z� Peal:Hgt. 3� <br /> Lot Covera�e: 12 • S <br /> Gradino: Staff Approval Date: �1 - l 3 -c�o By: o��• Council Approval Date: <br /> Sepuc: Staff Approval Date: n/ �� By: <br /> Zoaing File: � — Resolution: ; -" Resolucion Dace: _ . <br /> Shoceland District: e.� <br /> Avg. Setback. 0. �- Biufi Setback: I LotCovera�e: /Z• 5 <br /> E���a Propos�d <br /> Hardcover: 0-75' N�� <br /> 75-250' Sn. ���.6� <br /> 250-500' ---- <br /> 500-1000' ---- <br /> Hudcover Variance Required: Yes No_ L Date of Council Approval: <br /> RE�IA.��,S (in house): <br /> 7 <br />