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�CKECg pFF i,IST FOR ISSUANCE OF �'E�'�'nTS <br /> FO OFFICE USE ONL1'� <br /> p,pp�ESS OR LEGAL: ���(.' � , ���' <br /> �; tC � ff � C' �� � �-/'�'. <br /> PID: <br /> pESCRIPTION OF WORK: �oo� <br /> ------ - <br /> _----_____------- -----------____�____ pATE APPROVED: <br /> ZOVI�tG �tEVIEtiV �Y: . DAT`E APPROVED; �-3 0•d"1 . � <br /> BULLDING REVIE�V $Y: . . <br /> �`EES TO BE CHARGEp: y� Misc. Fees Calculated By: <br /> P���T Yes ✓ No <br /> PLAN REVIE`V � Yes —� No SE�YER C�i�INECTION <br /> � �ra tiVATERCONNECTION <br /> STATE SURCHARGE Yes No p�.K FBE <br /> INVESTIGATION FEE �'eS No –�G� SITEINSPECTION <br /> S AC Yes <br /> Number of SAC�Units __________ <br /> OTHER (specify) <br /> -------------------- <br /> ---------------- <br /> ---------------- - <br /> �py1��� C�+ CK LXST Zoaing District: ��_ � <br /> Post Office: School District: � <br /> Fire Department: . � <br /> �� ���-Acres `, �/ Width �C" " Dep[h <br /> L,ot Area; Sq.ft. __ <br /> Survey Submitted: Yes <br /> �o Date of Survey: `"/ � <br /> �roposed Setbacks: g���Side: ' � <br /> Froa[(Lake); � <br /> P.ear(Street): Left Side: <br /> ,�ld)3�PIIf Srnirh1r�.:: �Z/vtl�r rj; <br /> auilding Hei�t: DeE. I-�gt. peal`Ho�' <br /> Lot Covera�e: '�� ��� <br /> g Council_ Approval Date: _ ' <br /> GradLn�; Staff Approval Date: Y� <br /> Septic: Staff Approvai D2te: /� �Y� �'—� <br /> 7oaing File: � <br /> Resolutioo: n___ Resolution Da'e: <br /> Shorelznd District: ��Cove�.�e: <br /> AvQ. Setbacc_: B!uf`SetSack: <br /> � Proposed <br /> �tsti.eo <br /> H�eco��er: G-7�' <br /> 7�-2�0' <br /> ZJ`u'-�UU� <br /> �CO-iC�C'�' <br /> n� �. �i�- ��� -" V- LC^.--�. .���- � -�: <br /> }-rar�,`•�';2•' ti Z':_._.:.� _ _ti�_'.:"2`. � . � <br /> F.��L`�:�� �.L�ho��e�: <br />